surguja suposhan abhiyan -...
TRANSCRIPT
CENTRE FOR LEARNING RESOURCES, PUNE
Surguja Suposhan Abhiyan Baseline Study – March 2013
State Health Resource Centre, Chhattisgarh
This document is a report of the Fulwari baseline study conducted in Surguja district of Chhattisgarh, undertaken for the State Health Resource Centre (SHRC), Chhattisgarh in order to provide a baseline status of a) health and nutrition of and b) health care services and practices for, pregnant women and children in the age group of 0-3 years. UNICEF facilitated the study and provide a grant to support it.
2
3
TABLE OF CONTENTS
1 EXECUTIVE SUMMARY .............................................................................................................. 11
2 INTRODUCTION ........................................................................................................................ 12
SOCIO-DEMOGRAPHIC CONTEXT ..................................................................................................................... 12
2.1.1 Malnutrition in India ........................................................................................................... 12
2.1.2 Location of the study: Chhattisgarh State ........................................................................... 12
2.1.3 Location of the study: Surguja District ................................................................................ 13
3 FULWARI PROGRAM ................................................................................................................. 14
4 OBJECTIVES OF THE STUDY........................................................................................................ 16
5 STUDY DESIGN .......................................................................................................................... 17
SAMPLING .................................................................................................................................................. 17
METHODS .................................................................................................................................................. 19
5.1.1 Data collection methods and instruments .......................................................................... 19
5.1.2 Data analysis ....................................................................................................................... 20 5.1.2.1 Statistical tools used ..................................................................................................................................... 20
5.1.3 Technical notes .................................................................................................................... 21 5.1.3.1 Use and interpretation of t-tests .................................................................................................................. 21 5.1.3.2 Anthropometric indices ................................................................................................................................ 22 5.1.3.3 Malnutrition Categories ................................................................................................................................ 23
6 PROFILE, TRAINING AND RECRUITMENT OF INVESTIGATING TEAM ............................................ 24
PROFILE ..................................................................................................................................................... 24
TRAINING ................................................................................................................................................... 24
RECRUITMENT ............................................................................................................................................. 25
7 PROFILE OF RESPONDENTS ....................................................................................................... 26
PROFILE OF RESPONDENTS – MOTHER’S OF CHILDREN AGED 0-3 YEARS ............................................................... 26
7.1.1 Demographic profile of respondents ................................................................................... 26
7.1.2 Economic profile of respondents ......................................................................................... 29
7.1.3 Household assets and facilities ........................................................................................... 30
PROFILE OF RESPONDENTS – PREGNANT WOMEN ............................................................................................. 33
8 FINDINGS ................................................................................................................................. 35
NUTRITIONAL STATUS OF CHILDREN AND POSSIBLE INFLUENCING VARIABLES .......................................................... 36
8.1.1 Age ...................................................................................................................................... 41
8.1.2 Gender ................................................................................................................................. 43
8.1.3 Caste category..................................................................................................................... 48
8.1.4 Household Income ............................................................................................................... 49
8.1.5 Primary source of livelihood ................................................................................................ 51
8.1.6 Access to NREGA benefits ................................................................................................... 53
8.1.7 BPL card status .................................................................................................................... 55
8.1.8 Ration card status ............................................................................................................... 56
4
8.1.9 Geographical location – the seven blocks ........................................................................... 58
8.1.10 Mother’s profile ................................................................................................................... 60 8.1.10.1 Mother’s education status ............................................................................................................................ 60 8.1.10.2 Mother’s age at marriage ............................................................................................................................. 62 8.1.10.3 Maternal work hours .................................................................................................................................... 63
STATUS OF COVERAGE AND USAGE OF HEALTH AND NUTRITION SERVICES FOR CHILDREN .......................................... 65
8.1.11 Supplementary nutrition ..................................................................................................... 65
8.1.12 Vaccination and supplements ............................................................................................. 65
8.1.13 Access to National Health Insurance Program (NHIP) ........................................................ 66
STATUS OF HEALTH AND NUTRITION PRACTICES FOR CHILDREN ............................................................................ 66
8.1.14 Health .................................................................................................................................. 67 8.1.14.1 Incidence and treatment of common illnesses amongst children ................................................................ 67 8.1.14.2 Weight monitoring ........................................................................................................................................ 75
8.1.15 Nutrition .............................................................................................................................. 76 8.1.15.1 Breast feeding and weaning practices .......................................................................................................... 76 8.1.15.2 Frequency of food intake and food composition .......................................................................................... 78
8.1.16 Kitchen Gardens .................................................................................................................. 80
STATUS OF PSYCHOSOCIAL CARE PRACTICES FOR CHILDREN.................................................................................. 83
HEALTH AND NUTRITION SERVICES AND PRACTICES FOR PREGNANT AND LACTATING WOMEN .................................... 87
8.1.17 Health and nutrition services: ............................................................................................. 88 8.1.17.1 Registering the pregnancy ............................................................................................................................ 88 8.1.17.2 Ante natal care (ANC) services ...................................................................................................................... 88 8.1.17.3 Institutional delivery ..................................................................................................................................... 89 8.1.17.4 Post partum care (PPC) services ................................................................................................................... 90 8.1.17.5 Supplementary nutrition ............................................................................................................................... 91 8.1.17.6 Access to National Health Insurance Program .............................................................................................. 91
8.1.18 Practices: Health and nutrition ........................................................................................... 91 8.1.18.1 Nutrition........................................................................................................................................................ 91 8.1.18.2 Presence of kitchen gardens ......................................................................................................................... 92 8.1.18.3 Workload of pregnant women, duration of resting ...................................................................................... 92
9 CONCLUSIONS .......................................................................................................................... 93
SUMMARY OF KEY FINDINGS ......................................................................................................................... 93
10 APPENDICES ....................................................................................................................... 102
APPENDIX 1: PROFILE OF RESPONDENTS: PREGNANT WOMEN ........................................................................... 102
APPENDIX 2: HEALTH AND NUTRITION SERVICES AND PRACTICES FOR PREGNANT AND LACTATING WOMEN ............... 109
APPENDIX 3: HYGIENE RELATED PRACTICES - PREGNANT WOMEN ...................................................................... 115
APPENDIX 4: HYGIENE RELATED PRACTICES – MOTHERS OF CHILDREN AGED 0-3 YEARS ......................................... 117
APPENDIX 5: PRACTICES FOR TREATMENT OF DIARRHEA FOR 0-6 MONTH OLDS .................................................... 119
APPENDIX 6: PRACTICES FOR TREATMENT OF FEVER FOR 0-6 MONTH OLDS ......................................................... 121
APPENDIX 7: PRACTICES FOR TREATMENT OF COLD AND COUGH FOR 0-6 MONTH OLDS ......................................... 122
APPENDIX 8: PRACTICES FOR TREATMENT OF DIARRHEA FOR 6 - 36 MONTH OLDS ................................................ 123
APPENDIX 9: PRACTICES FOR TREATMENT OF FEVER FOR 6 - 36 MONTH OLDS ...................................................... 125
APPENDIX 10: PRACTICES FOR TREATMENT OF COLD AND COUGH FOR 6 - 36 MONTH OLDS ................................... 126
APPENDIX 11: DETAILS OF WEIGHT MONITORING OF CHILDREN AGED 0-3 YEARS .................................................. 127
5
APPENDIX 12: BREAST FEEDING PRACTICES (0-6 MONTH OLDS) ........................................................................ 130
APPENDIX 13: AGE OF FULWARIS ON SURVEY DATE ........................................................................................ 131
6
LIST OF TABLES
TABLE 1: BLOCK WISE SAMPLE SIZES OF FULWARI HAMLETS AND NON-FULWARI HAMLETS............................................ 17
TABLE 2: ACTUAL SAMPLE SIZE COVERED ACROSS RESPONDENT CATEGORIES ..................................................................... 18
TABLE 3: SUMMARY OF INDICATORS TO BE STUDIED AND METHODS OF DATA COLLECTION ............................................................... 19
TABLE 4: WHO STANDARDIZED FLAG LIMITS FOR Z SCORES ....................................................................................................... 20
TABLE 5: RESPONDENTS' OWNERSHIP OF HOUSEHOLD ASSETS .................................................................................................. 31
TABLE 6: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON Z SCORES ...................................................................................... 36
TABLE 7: DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS .......................................................................................... 42
TABLE 8: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-FW HAMLETS ..................... 42
TABLE 9: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-NFW HAMLETS ................................... 42
TABLE 10: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-OVERALL .......................................... 42
TABLE 11: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WHZ VALUES ....................................... 43
TABLE 12: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND HAZ VALUES ....................................................... 43
TABLE 13: DISTRIBUTION OF CHILDREN BASED ON GENDER ............................................................................................. 43
TABLE 14: DISTRIBUTION OF CHILDREN BASED ON GENDER AND AGE ............................................................................... 44
TABLE 15: AGE CATEGORY-WISE GENDER BASED T-TEST OUTPUTS FOR FW AND NFW HAMLETS .................................................... 47
TABLE 16: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND WAZ VALUES ............................................................. 47
TABLE 17: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND WHZ VALUES ............................................................. 47
TABLE 18: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND HAZ VALUES .............................................................. 47
TABLE 19: DISTRIBUTION OF RESPONDENTS BASED ON CASTE CATEGORY ........................................................................... 48
TABLE 20: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND WAZ VALUES ............................................... 49
TABLE 21: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND WHZ VALUES ............................................... 49
TABLE 22: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND HAZ VALUES ................................................ 49
TABLE 23: DISTRIBUTION OF RESPONDENTS BASED ON MONTHLY HHI BRACKET ............................................................... 50
TABLE 24: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND WAZ VALUES ............................................ 50
TABLE 25: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND WHZ VALUES ............................................ 51
TABLE 26: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND HAZ VALUES ............................................. 51
TABLE 27: DISTRIBUTION OF RESPONDENTS BASED ON PRIMARY SOURCE OF LIVELIHOOD ................................................. 52
TABLE 28: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND WAZ VALUES ............................ 52
TABLE 29: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND WHZ VALUES ............................ 53
TABLE 30: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND HAZ VALUES ............................. 53
TABLE 31: DISTRIBUTION OF RESPONDENTS BASED ON NREGA CARD STATUS ................................................................. 54
TABLE 32: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND WAZ VALUES ............................................ 54
TABLE 33: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND WHZ VALUES ............................................ 54
TABLE 34: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND HAZ VALUES ............................................. 54
TABLE 35: DISTRIBUTION OF RESPONDENTS BASED ON BPL CARD STATUS ....................................................................... 55
TABLE 36: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND WAZ VALUES ................................................. 55
TABLE 37: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND WHZ VALUES ................................................. 56
TABLE 38: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND HAZ VALUES .................................................. 56
TABLE 39: DISTRIBUTION OF RESPONDENTS BASED ON RATION CARD STATUS ................................................................... 57
TABLE 40: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND WAZ VALUES ............................................ 57
TABLE 41: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND WHZ VALUES ........................................... 57
TABLE 42: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND HAZ VALUES ............................................ 57
TABLE 43: BLOCK WISE DISTRIBUTION OF RESPONDENTS ACROSS FW AND NFW HAMLETS .............................................. 58
TABLE 44: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON WAZ VALUES .......................................................... 59
7
TABLE 45: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON WHZ VALUES .......................................................... 59
TABLE 46: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON HAZ VALUES ........................................................... 59
TABLE 47: DISTRIBUTION OF RESPONDENTS BASED ON EDUCATIONAL PROFILE ................................................................. 60
TABLE 48: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND WAZ VALUES ........................... 61
TABLE 49: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND WHZ VALUES ............................ 61
TABLE 50: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND HAZ VALUES ............................. 62
TABLE 51: DISTRIBUTION OF RESPONDENTS BY AGE AT MARRIAGE ................................................................................... 62
TABLE 52: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND WAZ VALUES ................................. 63
TABLE 53: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND WHZ VALUES ................................. 63
TABLE 54: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND HAZ VALUES .................................. 63
TABLE 55: DISTRIBUTION OF RESPONDENTS BASED ON MATERNAL WORKING HOURS ........................................................ 64
TABLE 56: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND WAZ VALUES .................................. 64
TABLE 57: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND WHZ VALUES .................................. 65
TABLE 58: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND HAZ VALUES................................... 65
TABLE 59: STATUS OF VACCINATION OF CHILDREN IN THE AGE GROUP 6-36 MONTHS IN FW AND NFW HAMLETS .............................. 66
TABLE 60: DURATION OF IRON SYRUP INTAKE......................................................................................................................... 66
TABLE 61: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS - CHILDREN AGED 0-6 MONTHS .............................................. 67
TABLE 62: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -CHILDREN AGED 6 MONTHS - 3 YEARS.................................... 68
TABLE 63 : STATUS OF CHILDREN’S WEIGHT MONITORING......................................................................................................... 76
TABLE 64: FOOD COMPOSITION - CHILDREN 6 MONTHS - 3 YEARS ............................................................................................ 80
TABLE 65: PREVALENCE OF KITCHEN GARDENS .................................................................................................................. 80
TABLE 66 PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND WAZ VALUES........................................ 81
TABLE 67: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND WHZ VALUES ...................................... 81
TABLE 68: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND HAZ VALUES ....................................... 81
TABLE 69: PSYCHOSOCIAL STIMULATION DURING BATHING TIME ................................................................................................ 83
TABLE 70: PSYCHOSOCIAL STIMULATION DURING MEAL TIME .................................................................................................... 84
TABLE 71: PSYCHOSOCIAL STIMULATION DURING SLEEP TIME .................................................................................................... 85
TABLE 72: PSYCHOSOCIAL STIMULATION DURING FREE TIME ..................................................................................................... 86
TABLE 73: PSYCHOSOCIAL STIMULATION DURING TOY TIME....................................................................................................... 87
TABLE 74: STATUS OF USAGE OF ANC SERVICES BY LACTATING MOTHERS AND PREGNANT WOMEN .................................................... 88
TABLE 75: TYPE OF DELIVERY - LACTATING WOMEN / MOTHERS OF 0-6 MONTHS OLDS ..................................................... 89
TABLE 76: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WAZ VALUES ................................................. 90
TABLE 77: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WHZ VALUES ................................................ 90
TABLE 78: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND HAZ VALUES ................................................. 90
TABLE 79: FOOD COMPOSITION - PREGNANT WOMEN ............................................................................................................ 91
TABLE 80: FOOD COMPOSITION - LACTATING MOTHERS .......................................................................................................... 92
TABLE 81: COMPARATIVE PROFILE OF RESPONDENTS ON SELECT DEMOGRAPHIC INDICATORS ........................................................... 99
TABLE 82: VARIATION IN DISTRIBUTION OF WAZ ACROSS SELECT DEMOGRAPHIC INDICATORS BETWEEN FW AND NFW HAMLETS ......... 99
TABLE 83: VARIATION IN ADOPTION OF SUGGESTED HEALTH AND NUTRITION PRACTICES BETWEEN FW AND NFW HAMLETS ............... 100
8
LIST OF FIGURES
FIGURE 1: AGE DISTRIBUTION OF RESPONDENTS .................................................................................................................... 26
FIGURE 2: RESPONDENT’S AGE AT MARRIAGE ........................................................................................................................ 26
FIGURE 3 : CASTE PROFILE OF RESPONDENTS ......................................................................................................................... 27
FIGURE 4: YEARS OF EDUCATION RECEIVED BY RESPONDENTS ................................................................................................... 27
FIGURE 5: RESPONDENT DISTRIBUTION BY NUMBER OF PREGNANCIES ........................................................................................ 28
FIGURE 6: RESPONDENT DISTRIBUTION BY NUMBER OF CHILDREN ............................................................................................. 28
FIGURE 7: TOTAL HOUSEHOLD MONTHLY INCOME.................................................................................................................. 29
FIGURE 8: HOUSEHOLD'S ACCESS TO AND STATUS OF AVAILING NREGA BENEFITS ....................................................................... 29
FIGURE 9 : HOUSEHOLD'S PRIMARY SOURCE OF LIVELIHOOD ..................................................................................................... 30
FIGURE 10: HOUSEHOLD'S BPL CARD STATUS ....................................................................................................................... 30
FIGURE 11: RATION CARD STATUS OF HOUSEHOLDS ............................................................................................................... 30
FIGURE 12: RESPONDENT DISTRIBUTION BY TYPE OF HOUSE ..................................................................................................... 31
FIGURE 13: RESPONDENT DISTRIBUTION BY OWNERSHIP OF HOUSE ........................................................................................... 31
FIGURE 14: COOKING FUEL USED ........................................................................................................................................ 32
FIGURE 15: PLACE OF COOKING .......................................................................................................................................... 32
FIGURE 16: USE OF SMOKELESS CHULHA .............................................................................................................................. 32
FIGURE 17: SOURCE OF DRINKING WATER ............................................................................................................................ 32
FIGURE 18: TOILET FACILITY AVAILABLE TO RESPONDENTS ....................................................................................................... 33
FIGURE 19: RESPONDENTS' ACCESS TO ELECTRICITY ................................................................................................................ 33
FIGURE 20: OVERALL DISTRIBUTION OF WAZ AGAINST WHO STANDARDS ............................................................................ 37
FIGURE 21: OVERALL DISTRIBUTION OF WHZ AGAINST WHO STANDARDS ............................................................................ 38
FIGURE 22: OVERALL DISTRIBUTION OF HAZ AGAINST WHO STANDARDS ............................................................................. 39
FIGURE 23: DISTRIBUTION OF WAZ AGAINST WHO STANDARDS IN FW HAMLETS ................................................................. 40
FIGURE 24: DISTRIBUTION OF WAZ AGAINST WHO STANDARDS IN NFW HAMLETS ............................................................... 41
FIGURE 25: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS FOR ALL HAMLETS ............................................ 44
FIGURE 26: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS - FW HAMLETS ............................................... 45
FIGURE 27: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS - NFW HAMLETS ............................................ 46
FIGURE 28: AVERAGE WAZ BY CASTE CATEGORIES.................................................................................................................. 48
FIGURE 29: DISTRIBUTION OF WAZ BASED ON HOUSEHOLD INCOME - FULWARI .......................................................................... 50
FIGURE 30: DISTRIBUTION OF WAZ BASED ON HOUSEHOLD INCOME - NON FULWARI ................................................................... 50
FIGURE 31: AVERAGE WAZ BASED ON PRIMARY SOURCE OF LIVELIHOOD ...................................................................................... 52
FIGURE 32: AVERAGE WAZ BY NREGA CARD STATUS ............................................................................................................ 53
FIGURE 33: AVERAGE WAZ BY BPL CARD STATUS ................................................................................................................. 55
FIGURE 34: RATION CARD STATUS WISE AVERAGE WAZ .......................................................................................................... 56
FIGURE 35: BLOCK WISE AVERAGE WAZ ............................................................................................................................... 58
FIGURE 36: DISTRIBUTION OF WAZ BASED ON MOTHER’S EDUCATION STATUS - FULWARI................................................................ 61
FIGURE 37: DISTRIBUTION OF WAZ BASED ON MOTHER’S EDUCATION STATUS - NON FULWARI ...................................................... 61
FIGURE 38: DISTRIBUTION OF WAZ BASED ON MOTHER’S MARRIAGE AGE - FULWARI ..................................................................... 62
FIGURE 39: DISTRIBUTION OF WAZ BASED ON MOTHER’S MARRIAGE AGE - NON FULWARI ............................................................ 62
FIGURE 40: DISTRIBUTION OF WAZ BASED ON MATERNAL WORKING HOURS- FULWARI ................................................................... 64
FIGURE 41: DISTRIBUTION OF WAZ BASED ON MATERNAL WORKING HOURS - NON FULWARI ......................................................... 64
FIGURE 42: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS - CHILDREN AGED 0-6 MONTHS ............................................................ 67
FIGURE 43: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -CHILDREN AGED 6 MONTHS - 3 YEARS ................................................... 67
FIGURE 44: FLUID INTAKE DURING DIARRHEA - 0-6 MONTHS .................................................................................................... 69
9
FIGURE 45: MILK INTAKE DURING DIARRHEA - 0-6 MONTHS ..................................................................................................... 69
FIGURE 46: FLUID INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEARS ....................................................................................... 69
FIGURE 47: MILK INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEARS ....................................................................................... 69
FIGURE 48: FOOD INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEAR OLDS ................................................................................ 69
FIGURE 49: FLUID INTAKE DURING FEVER- 0-6 MONTHS.......................................................................................................... 71
FIGURE 50: MILK INTAKE DURING FEVER- 0-6 MONTHS .......................................................................................................... 71
FIGURE 51: FLUID INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS ............................................................................................ 72
FIGURE 52: MILK INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS ............................................................................................. 72
FIGURE 53: FOOD INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS ............................................................................................ 72
FIGURE 54: FLUID INTAKE DURING COLD AND COUGH- 0-6 MONTHS ......................................................................................... 74
FIGURE 55: MILK INTAKE DURING COLD AND COUGH- 0-6 MONTHS .......................................................................................... 74
FIGURE 56: FLUID INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS .......................................................................... 74
FIGURE 57: MILK INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS ........................................................................... 74
FIGURE 58: FOOD INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS .......................................................................... 75
FIGURE 59: TIME OF FIRST BREAST FEEDING OF A NEWBORN .................................................................................................... 77
FIGURE 60: STATUS OF COLOSTRUM BEING GIVEN TO NEW-BORNS ........................................................................................... 78
FIGURE 61: INFANTS AGED 0-6 MONTHS - GIVEN FOOD OTHER THAN MOTHER'S MILK IN LAST 1 MONTH ..................................... 78
FIGURE 62: INFANTS AGED 0-6 MONTHS BEING BREASTFED BY MOTHER ................................................................................... 78
FIGURE 63: TIME OF STARTING COMPLEMENTARY NUTIRTION .................................................................................................. 78
FIGURE 64: FREQUENCY OF EATING - CHILDREN AGED 6 MONTHS - 3 YEARS ............................................................................... 79
FIGURE 65: FREQUENCY OF ADDING OIL TO FOOD - CHILDREN AGED 6 MONTHS - 3 YEARS ........................................................... 79
FIGURE 66: AVERAGE WAZ BY KITCHEN GARDEN STATUS ........................................................................................................ 80
10
11
1 EXECUTIVE SUMMARY
This study of nutritional status and health and nutrition practices, including the use of relevant health services,
prevalent in Surguja district was undertaken by Centre for Learning Resources to provide a base-line for the
Fulwari programme, in Surguja. This programme is conceived as a community-led, government-supported el-
ement of the Surguja Suposhan Abhiyan. With technical and implementation support from State Health Re-
source Centre (SHRC), village mothers run community creches, called Fulwaris, which provide 3 hot meals a
day and care and attention for about 7 hours to children under 3 years.
This baseline study was undertaken to assess the nutritional status of the under-3 children in the district, to
assess the adoption of recommended nutritional, health-care and psychosocial practices for them and access
and usage of health and nutrition services by pregnant and lactating women.
The study was conducted in 80 fulwari hamlets and 50 non-fulwari ones. The average age of the fulwari on the
day of the survey was 56 days. Height and weight data on all the relevant children in the selected hamlets was
collected. In addition, various demographic variables and healthcare, nutritional and psycho-social practices
were studied for a smaller subset of the children as well as for a sample of pregnant women. WHO Child
Growth standards were used to establish nutritional status and link it to the demographic and practice variables.
The study concludes that malnutrition is significant and pervasive in Surguja, with the average weight-for-age
z-score at -1.85 (“Moderate Malnutrition” category begins at -2.00). When analysed based on various demo-
graphic indicators, the differences were mostly small. However, significant differences emerged between fulwari
and non-fulwari hamlets, with the average resident in the non-fulwari hamlet better off than in the fulwari
hamlet. Moreover, the differences between the better off and the not-so-well-off were markedly more stark in
fulwari hamlets than in the non-fulwari ones, suggesting that the fulwaris were finding their target hamlets
reasonably well. And while the fulwaris had been established too recently to warrant any firm conclusions, it
did seem that in the fulwari hamlets, the awareness of desirable health-care practices was somewhat higher.
The study also suggests that the awareness of beneficial health and nutritional practices is fairly high but not
universal. While vaccination and supplementary nutrition practices seem well-adopted, the adoption of other
practices is weaker and suggests the need for attention to a behaviour change effort. Relatively little attention
is paid by parents to stimulating the psycho-social capacities of children; awareness of the value of complex
talk, versatile toys and self-reliant activities needs to be enhanced through appropriate parenting education.
12
2 INTRODUCTION
The Fulwari baseline study conducted in Surguja district of Chhattisgarh was undertaken for the State Health
Resource Center (SHRC), Chhattisgarh in order to provide a baseline of status of a) health and nutrition of and
b) health care services and practices for, children in the age group of 0-3 years. This baseline data will be used
for assessing the impact and effectiveness of SHRC’s recent health intervention, the community crèches inter-
vention called the Fulwari program. The study was coordinated by the Center for Learning Resources, Pune.
The study was part-funded by UNICEF.
Socio-demographic context
2.1.1 Malnutrition in India
As per the National Family Health Survey 3 (NFHS 3), carried out in 2005-06, 40% of children in India under
the age of three years are underweight for their age. The study puts the number of stunted children under the
age of three, i.e. children who are too short for their age, at 45%. On a third critical indicator of child health,
the measure of weight to height, 23% of children under three years fail to meet the normal standards and suffer
from what is called wasting. The World Bank puts it into perspective in the global context, “Rates of malnutrition
among India’s children are almost five times more than in China, and twice those in Sub-Saharan Africa.”1
High prevalence of malnutrition in children aged up to three years is a grave concern as studies show that the
damage caused to the physical, psychosocial and brain development of the child in these early stages is accu-
mulative and largely irreversible. It reduces their chances of survival, reduces their immunity and makes them
more susceptible to illnesses, adversely affects their ability to learn and to continue in school at later stages in
life.
2.1.2 Location of the study: Chhattisgarh State
Chhattisgarh is a relatively young Indian state, which was carved out of Madhya Pradesh in November 2000. It
is one of India’s most resource-rich states: it has large reserves of coal, iron ore, tin, dolomite, limestone and
bauxite; it produces 15% of the country’s steel and 20% of its cement and is one of the few Indian states with
a comfortable electricity situation. 12% of India's forest cover falls in Chhattisgarh: 44% of the State's land is
under forests and wood, tendu leaves, honey and lac are significant forest resources. It is identified as one of
the richest bio-diversity habitats. One third of Chhattisgarh's total population of nearly 25 million is tribal,
living mostly in the thickly forested areas in the North and South. (http://cg.gov.in/profilenew/profile1.htm )
Female literacy rate as per the 2011 national census was 60.5%, an approximately 100% rise over the last decade,
and male literacy according to the same survey stands at 81.4% which is marginally higher than India's average.
Chhattisgarh’s sex ratio is 991 while its child sex ratio is 964, considerably higher than the national sex ratio of
914.
1 (Helping India Combat Persistently High Rates of Malnutrition – World Bank article -
http://www.worldbank.org/en/news/feature/2013/05/13/helping-india-combat-persistently-high-rates-of-malnutrition).
13
However, child health indicators remain a significant challenge for Chhattisgarh. The ratio of underweight
children, under the age of 5, in Chhattisgarh is more than 40%.. A World Bank report states, “Six states - Bihar,
Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan, and Uttar Pradesh - account for over half of India’s malnutrition cases.”
More than 70% of the state’s children are anaemic2. The infant mortality rate (IMR) in Chhattisgarh was 51,
the sixth-highest of the 20 large states in the country and above the national average of 473. Of this, neonatal
mortality rate stands at 35 and post neonatal mortality rate at 16. The under 5 mortality rate (U5MR) was 61,
the seventh highest among large states, compared to the national average of 594.
2.1.3 Location of the study: Surguja District
Surguja is a northern district of Chhattisgarh sharing borders with four other states, Jharkhand, Orissa, Madhya
Pradesh and Uttar Pradesh. The high-lands of Surguja district have peculiar 'pat formations' – highlands with
small tablelands. As per NFHS-3 its population is approximately 2.3 million of which nearly 90% is rural; 54.6%
of the total population is tribal. Children under the age of 6 years constitute 16.53% of the total population and
the child sex ratio is 967 which is marginally higher than the state sex ratio. While it is rich in mineral and forest
resources, agriculture forms the main source of livelihood with more than 80% of the population being culti-
vators or agricultural labourers.
As per Chhattisgarh’s Annual Health Survey Bulletin 2011-12, Surguja’s IMR is 55, compared to the state IMR
of 50. However, this similarity hides a rather alarming deterioration of mortality rates with children’s ages.
Surguja’s neo-natal mortality rate (children dying within a month of birth) is 31, lower than the state level of
35. However, it has the highest post-neonatal mortality rate (PNMR) (children dying after a month but before
one year of birth) of 24 among all Chhattisgarh districts, much higher than the state’s PNMR of 16. Similarly,
U5MR, at 96 for Surguja, is the highest of all districts in the state; the state value is 66. Clearly, the care of
children under five in Surguja presents significant challenges for the community as well as the state govern-
ment5.
2 National Family Health Survey 3 (2005-06), Ministry of Health and Family Welfare
3 Sample Registration System 2010
4 Sample Registration System 2010
5There appear to be some inconsistencies between SRS 2010 and numbers reported in Chhattisgarh Health Survey Bulletin 2011-12 for 2010. These might be due to reporting data without differentiating between Surguja divided and undivided. These have been ignored for the purpose of this discussion; they do not alter the thrust of the argument.
14
3 FULWARI PROGRAM
These challenges and the urgent need for action led SHRC to identify Surguja as the pilot location for their
fulwari program. As conceived, it is a community-run and government-supported intervention which is a part
of the Zila Panchayat’s Surguja Suposhan Abhiyan aimed at battling the widespread malnutrition (47% of children
are underweight) prevalent amongst children in Chhattisgarh. Mothers from poor families have a lot of work-
load which also involves going for work outside home. Thus, poverty creates two kinds of factors that increase
child malnutrition among the poor: a) lack of access to high nutrition foods b) lack of availability of adequate
amount of time for child feeding and care. Fulwaris are community run crèches that attempt to address these
two issues by providing a place where mothers can leave their children in good care for 7-10 hours where the
children receive the attention they require and eat at least 3 hot meals a day. Moreover, recognizing the critical
importance of psychosocial stimulation during the early years of the child, both for increasing the nutritional
intake of the child, and for holistic development, the crèche also aims to enhance the quality of psychosocial
care by mothers.
The fulwari program is based on what is known as the ‘Caregivers Group Model’ which has been implemented
by international NGOs in Malawi in Africa. This model involves creating a group of caregivers from the com-
munity who take primary responsibility for improving the health and nutrition status of children less than 3
years of age. In Surguja, Fulwaris are run by the local community through a group of mothers. Also, parents
(or grandparents) having children (below the age of three years) in each habitation and pregnant women are
brought together into a group. Formation, coordination and activities of this group are facilitated by the
Mitanin. These meetings provide the Mitanin an opportunity to interact with this critical set of families on child
care issues.
The technical and implementation support for running the fulwaris is being provided by the State Health Re-
source Center (SHRC), Chhattisgarh. The program is being piloted by SHRC in Surguja district in 300 hamlets
across the district. Direct cash assistance is provided by the Zila Panchayat to the mothers’ groups (through the
Gram Panchayats). (The state government has announced its intention to expand the programme to 85 blocks
across the state).
The key activities targeted towards and undertaken by the mother’s group of the fulwari are:
Running community crèches to focus on needs of children below 3 years of age: Zila Panchayat provides an average
fund of Rs. 50,000 per annum per habitation to run the community crèches. The grant is given to
Gram Panchayat which in turn issues it to the mothers’ group in instalments. At least 80% of the grant
is meant to be utilized to provide wholesome hot cooked food to children, pregnant and lactating
women. The rest is utilized to equip the crèche with essential utensils, toys, mosquito nets, mats etc.
The crèche is run for at least 7 hours a day. The timings are decided by the community in the Village
Health, Nutrition and Sanitation Committee (VHNSC) meetings. It thus makes it possible for mothers
to go for work while leaving their 6 month-3 year old children at the fulwari. The place or building for
setting up the fulwari is also decided by the community. It is usually part of a private house voluntarily
given for the purpose by the resident.
The focus is on children under the age of 3 years, who require interventions complementing the exist-
ing strategy of giving them dry Ready to Eat Take Home Rations and growth monitoring (through
ICDS) and immunization (through VHND).
15
Educating caregivers on appropriate nutrition, physical health care and psychosocial care for 0-3 year olds: The crèche
brings together the Caregivers group as the food for their children acts as an incentive. Here, desirable
practices of food preparation and child feeding are demonstrated to them. Mitanins provide counsel-
ling to families regarding child feeding and healthcare practices. SHRC also aims to use this crèche as
a medium to educate mothers about appropriate caregiving practices that enhance the psychosocial
development of children.
Promoting kitchen gardens in caregiver homesteads: The caregivers’ group is encouraged to develop kitchen
gardens as this will help provide fruits and vegetables which are an important source of nutrition.
Backyard poultry is also promoted for similar reasons.
Other activities of the fulwari include promoting various livelihood initiatives in the hamlets.
16
4 OBJECTIVES OF THE STUDY
This baseline study focuses on the key parameters which shape the activities of the Fulwari program. These are
nutritional status of children; nutritional, physical care and psychosocial care of children; and, adoption of
nutritional and health care services by pregnant and lactating women. Based on these parameters, the following
aims shaped the study.
1. To assess the nutritional status of children in the age group of 0-3 years.
2. To assess the extent to which parents of 0-3 year olds engaged in recommended nutritional practices,
physical health care practices and psychosocial care practices.
3. To assess the status of access and usage of recommended health and nutrition services by pregnant
women and lactating women.
17
5 STUDY DESIGN
Sampling
It was decided that the overall sample would comprise two groups of hamlets, one where fulwaris were being
established and another where they weren’t. Accordingly, this baseline study was conducted in 130 hamlets. Of
these, fulwaris in 80 had started and the mean age of fulwaris, i.e. the period between the commencement of
fulwari operations and the date of survey was 56 days. (For more details refer to Appendix 13). There were no
fulwaris in the other 50.
The block-wise sample size of the fulwari hamlets (FW) was based on the proportion of fulwari hamlets it had
out of the total of 300 fulwari hamlets. Similarly the block-wise sample size of the non-fulwari hamlets (NFW)
was based on the proportion of non-fulwari hamlets it had out of the total of 2765 such hamlets.
While the baseline design split the sample between hamlets where fulwaris existed and those where they didn’t,
it is unlikely that the non-fulwari locations will function as control locations. The intention is for fulwaris to be
opened wherever the local communities ask for them. It is, therefore, very likely that over the project period,
the hamlets which are not currently classified as fulwari hamlets will also establish them. Moreover, even if they
don’t, the likelihood that practices followed in the fulwari hamlets will diffuse into the neighbouring hamlets is
too great to allow the NFW to be treated as control locations. At the baseline stage, however, they have pro-
vided a sense of the differences in characteristics between the locations where the early adoption of fulwaris
has happened vs others (see the section “Conclusions”).
TABLE 1: BLOCK WISE SAMPLE SIZES OF FULWARI HAMLETS AND NON-FULWARI HAMLETS
Block Udaipur Batauli Lundra Lakhanpur Ambikapur Mainpath Sitapur Total
Block-wise non-fulwari hamlets sample size
NFW hamlets 273 390 415 439 551 368 329 2765
% split of NFW ham-
lets
10 14 15 16 20 13 12 100
Sample size on NFW
hamlets
5 7 8 8 10 7 5 50
Block-wise fulwari hamlets sample size
FW hamlets 62 32 50 49 29 32 46 300
% split of FW ham-
lets
21 11 17 16 10 11 15 100
Sample size of FW
hamlets
15 8 13 8 11 13 12 80
Total sample ham-
lets
20 15 21 16 21 20 17 130
18
After the block-wise sample sizes were determined, non-fulwari hamlets were selected through a purposive
random sampling from a list of hamlets, stratified at the block level. The randomly selected sample was modified
to provide for geographical spread across the block. Fulwari hamlets where fulwaris were inaugurated after 15th
Dec 2012 were considered (except two in Lundra) and those inaugurated most recently were selected. This was
done in order to minimize contamination of data due to changes in the nutrition, practices and services status
that might have already taken place due to the fulwari operations.
In each sample habitation, data for nutritional status i.e. height, weight and age was collected for all the children
in the habitation in the age group of 0-3 years. Data for understanding the status of nutrition, physical health
care and psychosocial care practices and adoption health related services was collected from six respondents
per habitation. Of the six respondents, two were pregnant women who were selected randomly from the hab-
itation. The other four respondents constituted of mothers, one each, of children aged birth-6 months, 6
months – 1 year, 1-2 years and 2-3 years. These four respondents were selected randomly out of the age-based
stratification of mothers of all children between birth to 3 years.
Table 2: ACTUAL SAMPLE SIZE COVERED ACROSS RESPONDENT CATEGORIES
Respondent category Data collected Actual sample size surveyed – FW hamlets
Actual sample size surveyed – NFW hamlets
Actual sample size
surveyed- overall
Children under the age of
three years
Height, weight and
age data through di-
rect screening
1036 662 1698
Mother / primary care-
taker of infants less than
6 months old – mostly lac-
tating women
Demographic infor-
mation, health and
nutrition practices
and psychosocial
care practices
69 41 110
Mother / primary care-
taker of infants aged be-
tween 6 and 12 months
66 46 112
Mother / primary care-
taker of children aged be-
tween 1-2 years
80 50 130
Mother / primary care-
taker of children aged be-
tween 2-3 years
77 50 127
Pregnant women Demographic infor-
mation, health and
nutrition practices
132 79 211
19
Methods
5.1.1 Data collection methods and instruments
Data for the study was collected through a structured interview and through direct screening of children. Direct
screening was used to collect height and weight data of all the children under the age of three years in a sample
hamlet. All the questions in the structured interview were closed ended. Some of the questions permitted mul-
tiple responses, while others permitted only one possible response. The height and weight were measured using
standardized instruments. Children’s height was measured in a recumbent position, using an infantometer.
TABLE 3: SUMMARY OF INDICATORS TO BE STUDIED AND METHODS OF DATA COLLECTION
Indicators Sources of data Sample Methods
Nutritional status :
Height, Weight, Age
Direct Measurement of
Height and Weight;
Age reported by par-
ent/caregiver
All children 0-3 years in the
habitation
Direct Screening
Health and nutrition ser-
vices and practices
(dealing with diarrhea,
respiratory infection, fe-
ver, vaccination, feed-
ing)
Mother / primary care-
giver in absence of mother
Four children per habita-
tion (one each in age cate-
gories 0-6, 7-12, 13-24, 25-
36 months) selected ran-
domly out of the age-strat-
ified lists of all 0-3 years
children
Interview
Psychosocial care prac-
tices
Mother / primary care-
giver in absence of mother
Common sample for Pre-
ventive and curative
measures and Psychoso-
cial care
Interview
The interview questions could broadly be divided into 3 sections:
1. Demographic information: This included information about the respondent and her family like her age,
years of education, caste and economic status (source of livelihood, monthly income, BPL status,
household assets etc.)
2. Health and nutrition services and practices: Questions in this section explored aspects like food habits of the
mother and child, prenatal and post natal health practices, occurrence of common illnesses like diar-
rhea, fever and cold and practices for treating them.
3. Psychosocial care practices: This section explored the kind of stimulation and care the child receives for his
/ her psychosocial development. These questions are address four specific activities in the course of
the child’s daily like: bathing time, meal time, sleeping time and free time. It also examines the kind of
toys used by the caregivers, as toys are a crucial means of stimulation for the child.
20
The first section was common across respondent categories. For the second section i.e. health and nutrition
services a common interview tool was used for collecting data regarding children aged 6 months to a year and
a different questionnaire was used for infants aged 0-6 months. This was to capture more appropriately the
unique health care practices for breastfeeding children. The third section i.e. psychosocial care practices was
customized for each age category. Similar practices and aspects were explored but information sought varied in
the degree of detail and complexity. A separate interview tool was developed to collect relevant information
related to pregnant women. This broadly included antenatal care practices and services, access to and attitude
towards institutional delivery services etc. The questionnaires used are attached as Appendix 14.
The data was gathered by a two member investigating team supported by the SHRC network of District and
block coordinators, Mitanin Trainers and Mitanins. On an average a hamlet was covered in 2 days while in
exceptional circumstances it took three days.
5.1.2 Data analysis
World Health Organisation (WHO) Child Growth Standards (CGS) provides reference curves for three differ-
ent types of measurement. Weight for Age curves help identify “Underweight” children, Height for Age curves
“Stunted” children and Weight for Height curves “Wasted” children. In each case, the severity of under-nutri-
tion is measured by the z-score, a measure of the number of standard deviations a particular child is from the
median reference.
The Z scores for the entire population which included the 479 respondents, for whom detailed information
was collected, were calculated using WHO Anthro, World Health Organization’s software for analysis of nu-
tritional surveys. WHO has set standardized lower and upper standard deviation boundaries flag limits for
identifying any extreme or potentially incorrect z-score values for each indicator.
TABLE 4: WHO STANDARDIZED FLAG LIMITS FOR Z SCORES
Indicator Lower SD Upper SD
WAZ -6 +5
HAZ -6 +6
WHZ -5 +5
Values beyond these limits have been excluded when undertaking t-tests and generating scatter diagrams for
analysis.
5.1.2.1 STATISTICAL TOOLS USED
The analysis aims to a) assess the nutritional status of children, b) assess the status of health and nutrition
practices and services and c) explore the possible relationships or their absence between the nutritional status
of children and various socioeconomic variables.
1. For (a), we have used statistical measures like the average Z scores, standard deviation of the Z scores
and their frequency distribution in different ranges (Z score <-3, Z score < -2 etc.).
21
2. For (b), we have mostly used frequency distributions to understand degree of prevalence or absence
of certain practices and to understand the extent to which specific services are available and are being
used or not.
3. For (c), we have
a. Used scatter diagrams to represent the relationship between continuous variables like house-
hold income, mother’s age at marriage and WAZ. Had the scatter diagrams revealed any sig-
nificant relationships, we would have used regression analysis to characterise them but no such
relationships were observed.
b. Compared average and standard deviation of WAZ for categories like different blocks, ration
card status and poverty line status to determine whether any variations exist across these cat-
egories and whether they indicate any possible relationships between these variables and the
children’s nutritional status as represented by WAZ.
c. In addition, used the T-test for variables which had only two categories like poverty line status
and gender or in cases where there were two dominant categories like STs and OBCs in caste.
The analyses involving height, weight, age, gender and location of children have been run on the data of 1687
of the 1698 children who were directly screened for collecting this information. (11 children were excluded
from analysis as their WAZ values lie outside the WHO standardized flag limits for z scores (For flag limits,
please refer to Table 4)). Rest of the analyses use data collected from mothers of 479 children (0-6 month: 110,
6 months – 1 year: 112, 1-2 years: 130 and 2-3 years: 127).
5.1.3 Technical notes
5.1.3.1 USE AND INTERPRETATION OF T-TESTS
The use of z-scores in analyzing anthropometric data has a significant advantage over other methods which
rely on other forms of categorization; it can be modelled as a continuous variable, making it possible to perform
various operations such as calculation of means, standard deviations and, by extension, analyses such as regres-
sion and t-tests. We have used t-tests extensively in this document. A note on our approach to presentation of
t-test results is, therefore, in order.
A t-test produces two key insights; an effect-size, which is the difference between the means of the two cate-
gories being compared, and a probability that that effect arose by chance (this probability depends on a number
of factors, including the size of the sample and the variability seen in the sample). When the probability is low,
the effect is considered to be statistically significant.
It is usual to establish a significance level (P-value) cut-off at the 1% or 5% levels, implying that the likelihood
of the effect having arisen by chance is as low as 1% or 5%, respectively. While this ensures that only those
propositions that have a high likelihood of being true are accepted, we consider an exclusive attention to sta-
tistical significance levels for policy decisions as problematic.
For instance, if the difference in mean z-scores between two categories is large, but owing to the variability or
size of the sample, the significance levels fail to reach the high cut offs generally required, we would still consider
it worthy of further attention and possibly policy interventions. Similarly, if the difference between two samples
was small, but owing to low variability or large sample size generated a high statistical significance level, it might
warrant no discrimination between policy responses to the two groups. The present study has a large number
of such situations.
22
While for ease of reference, we have adopted the Cohen categorisation of effect sizes smaller than 0.2 as
“Small”, 0.2 to 0.5 as “Medium” and greater than 0.5 as “Large”, combining with P-values of less than 0.05 as
significant and more than 0.05 as not-significant, we draw attention to Cohen’s own qualifier:
"The terms 'small,' 'medium,' and 'large' are relative, not only to each other, but to the area of behavioral science or even more
particularly to the specific content and research method being employed in any given investigation....In the face of this relativity,
there is a certain risk inherent in offering conventional operational definitions for these terms for use in power analysis in as
diverse a field of inquiry as behavioral science. This risk is nevertheless accepted in the belief that more is to be gained than lost
by supplying a common conventional frame of reference which is recommended for use only when no better basis for estimating
the ES index is available." (p. 25)6
Accordingly, rather than characterize a particular difference only as statistically significant or otherwise, we have
consistently provided the group means and the corresponding P-value along with the above characterisations
for various comparisons. This will make it possible for the reader and the policy makers to take a more nuanced
view of the situation, and help decide what kind of an intervention response is appropriate.
5.1.3.2 ANTHROPOMETRIC INDICES
In India, the weight-for-age is the record used practically universally. For this reason, all the analysis in this
report is based on the weight-for-age z-scores. This should make it possible to relate future studies and analyses,
including those based on secondary data, easily to the results of this one. (For the sake of completeness, prev-
alence data for weight-for-height and height-for-age z-scores has also been provided, though no analysis has
been done with that data).
However, it is worth noting that using weight-for-age z-scores (WAZ) produces significantly different preva-
lence levels of malnutrition at various levels than using weight-for-height z-scores (WHZ). A t-test of the 1,638
observations made in Surguja (after excluding extreme values and blanks on either) showed a mean difference
in z-scores of 0.78, nearly a full category (mean WAZ: -1.80, mean WHZ: -1.02) with an extremely high statis-
tical significance (t-stat: 17.82, P(T<=t, one-tail): 4.78E-68). Similarly, while 44% of the overall sample had a
WAZ score of less than -2, only 22% had a WHZ score of less than -2. At z-scores of -3 or below, denoting
severe malnutrition, the WAZ indicator showed 15.8% prevalence, whereas the WHZ indicator showed 7.5%.
This suggests the need for care in interpreting malnourishment data. In this connection, the following comment
(Page 47) in WHO Global Database on Child Growth and Malnutrition (World Health Organisation, Geneva,
1997) is worth notice:
Weight-for-age ... is influenced by both the height of the child (height-for-age) and his or her weight (weight-for-height), and its
composite nature makes interpretation complex. For example, weight-for-age fails to distinguish between short children of
adequate body weight and tall, thin children.
Regardless of the measure used, the need for a substantial intervention for improving nutritional status is im-
mediate. The mean WHZ-score for the entire sample is -1.04 and the mean WAZ-score -1.85, suggesting a
major downward shift of an entire population as far as nutrition is concerned.
6 Jacob Cohen (1988). Statistical Power Analysis for the Behavioral Sciences (second ed.). Lawrence Erlbaum Associates
23
5.1.3.3 MALNUTRITION CATEGORIES
Standard labelling treats z-scores, calculated off the WHO CGS reference curves between -2 and -3 as “Mod-
erate” malnutrition and less than -3 as “Severe” malnutrition. The WHO system has seen increasingly wide-
spread adoption and India, too, uses it. Accordingly, this is the system we have used here.
24
6 PROFILE, TRAINING AND RECRUITMENT OF INVESTI-
GATING TEAM
Profile
For carrying out the baseline study, Mitanins, block and district coordinators mobilized 40+ local village youth
from different blocks. Majority of these youth were in the age group of 18-22 and had either just completed or
were undergoing their grade XII / under graduation studies. Another set of youth were young housewives who
were stepping out to work for the first time while there were also men in the age group of 25-35 who were
otherwise engaged in agricultural activities. Most of the investigators knew about the health related work being
undertaken by Mitanins but none of them had any prior work experience in the field.
Training
These prospective investigators underwent a three day training to understand the context, the purpose of the
study, data collection tools and processes.
Training methodology : Discussions, videos followed by debriefs and discussions, role plays, on-field prac-
tice of implementing the tools, presentations, activities like debates, games, peer reviews
Trainers: The training was conducted jointly by representatives from SHRC and CLR.
Training plan:
S. No. Training agenda / objective
Day 1
1 Introduction to Fulwari and Baseline Study
2 Expectation sharing, understanding the role of investigators, nature and duration of the work, terms
of payment.
3 Introduction to Holistic Child Care and Development - Health, Nutrition, Psychosocial, various
role holders in a child’s development
4 Introduction to Tools on 3 aspects- Health, Nutrition, Psychosocial
5 Introduction to Tools(Health, Nutrition, Psychosocial)
25
Day 2
1 Field visit - Using the tool with caregivers in the villages. Trainers observed the investigators on
field, provided support and collated specific feedback
2 Discussion on difficulties faced in the field while using the tool
Day 3
1 Based on field visit and investigators’ questions further discussion on tools with focus on building
rapport with the respondents, asking difficult questions like income, age, psychosocial section.
2 Expectation sharing, understanding the role of investigators, nature and duration of the work, terms
of payment.
Recruitment
Out of the 40 participants, 32 were selected to carry out the investigation for the baseline study. The selection
was based on the recommendations of the training team which closely interacted with the participants. The
trainers particularly observed the participants during the field visit from the point of view of checking fit for
the work. Simple criteria were used for selecting the final investigating team:
Willingness to take up the work and on-field performance were selection criteria. The ease of connect-
ing with the respondents, ability to follow the prescribed processes, ability to draw required responses
from the respondents, ability to work in a team, enthusiasm and motivation for field work were con-
sidered.
Understanding of the task, tools and processes as indicated during participation in the training was
considered as a selection criteria.
Sixteen two person teams were formed. These were formed such that the team members were from the same
block and preferably lived close to each other and brought in complementary skills like quick rapport building
and precision in recording.
26
7 PROFILE OF RESPONDENTS
As a first step towards understanding the results of the baseline study, we have looked at the demographic and
economic profile of the respondents. Later sections explore the possible relationships between these charac-
teristics and the nutritional status of the children.
Profile of Respondents – Mother’s of children Aged 0-3 years
This section discusses the profile of the 479 respondents who were mothers of children aged 0-3 years inter-
viewed to understand the children’s nutritional status, health and nutrition services and practices. Of these 292
were from FW hamlets and 187 from NFW hamlets.
7.1.1 Demographic profile of respondents
Given that the target respondents were mothers of young children, both in FW and NFW hamlets, more than
half were young women under the age of 25 and more than a quarter fell in the age group of 26 to 30 years.
13.4% women from FW and 11.2% from NFW hamlets were older than thirty years. Also, nearly 4% women
didn’t know their age even in approximate terms. Statistics on “age at marriage” show that in FW and NFW
hamlets, nearly 41% of respondents were married before they attained the legal marriageable age of 18 years. A
similar percentage of FW respondents got married between the age of 18 and 20 years while this number was
39% for NFW hamlets.
FIGURE 1: AGE DISTRIBUTION OF RESPONDENTS
FIGURE 2: RESPONDENT’S AGE AT MARRIAGE
The caste profile of the respondents is in keeping with the overall population composition of Surguja with the
highest percentage belonging to the Scheduled Tribes, followed by the next highest proportion coming from
the Other Backward Classes category. The proportion of ST respondents in the FW hamlets is higher (68.5%)
than in NFW hamlets (60.4%). IN terms of respondents from the OBC category, this trend is reversed with
FW hamlets reporting a lower percentage (24%) of respondents from OBC category than those in NFW ham-
lets (30%).
2.4
%
51.7
%
28.8
%
13
.4%
3.8
%
2.1
%
51.9
%
30.5
%
11.2
%
4.3
%
2.3
%
51.8
%
29.4
%
12.5
%
4.0
%
<20 Yrs 20-25 Yrs 26-30 Yrs >30 Yrs No Resp.
FW NFW Overall
41.4
%
41.1
%
9.6
%
1.7
%
0.3% 5.
8%
41.2
%
39.0
%
12.
8%
1.6
%
0.0
% 5.3%
41.3
%
40.3
%
10.9
%
1.7%
0.2
% 5.6
%
<18 Yrs 18-20 Yrs 21-25 Yrs 26-30 Yrs >30 Yrs No Resp
FW NFW Overall
27
In terms of education, just over half the respondents from FW hamlets and 47% from NFW hamlets were
illiterate. Thus the FW numbers are markedly higher than the overall Census figures for Chhattisgarh which
stand at 44.5 % for rural women. The overall trend of the education profile of respondents shows that, though
only marginally so, the NFW respondents are better off in terms of number of years of education than their
FW counterparts.
FIGURE 3 : CASTE PROFILE OF RESPONDENTS
FIGURE 4: YEARS OF EDUCATION RECEIVED BY RESPONDENTS
Both in FW and NFW hamlets, just over a fifth of the respondents had been pregnant only once while 2
pregnancies were found to be most prevalent in NFW hamlets with 40%% of the women falling under that
category. For the FW hamlets, 3 pregnancies were most prevalent with 28.4% women falling under this cate-
gory. While 12.3% women from FW hamlets reported being pregnant more than four times, only 6.5% women
reported the same from NFW hamlets.
2.7%
4.1%
68
.5%
24.0
%
0.3%
0.3%3.
2% 5.9%
60
.4%
29.9
%
0.0%
0.5%2.9% 4.8%
65
.3%
26.3
%
0.2%
0.4%
General SC ST OBC Others UnKnown
FW NFW OVERALL
53
.8%
9.9% 12
.7%
15.4
%
6.2%
2.1%
47
.1%
5.9%
17.1
%
17.6
%
7.0%
5.3%
51
.1%
8.4% 14
.4%
16.3
%
6.5%
3.3%
Illiterate 1-4 5-7 8-9 10-11 12 andAbove
FW NFW Overall
28
FIGURE 5: RESPONDENT DISTRIBUTION BY NUMBER OF PREGNANCIES
The highest proportion of women both in FW and NFW hamlets, more than 30%, reported having only one
child. Approximately a quarter of the women from FW hamlets reported having 2 children and a little over a
quarter reported having 3 children. 31.6% from NFW hamlets reported that they had 2 children while 18.7%
said they had 3 children. While 17% FW respondents reported having 4 or more children, the same was re-
ported to be 15% for NFW respondents.
Although women from both FW and NFW hamlets reported similar age and ‘age at marriage’ profiles, FW
respondents show a tendency of more pregnancies and more children than the NFW respondents.
FIGURE 6: RESPONDENT DISTRIBUTION BY NUMBER OF CHILDREN
22
.6%
24
.3%
28
.4%
12
.3%
7.5
%
2.4
%
0.7
%
1.7
%
0.0
%
21
.0%
39
.8%
18
.8%
14
.0%
4.8
%
1.1
%
0.5
%
0.0
%
0.5
%
22
.0%
30
.3%
24
.7%
13
.0%
6.5
%
1.9
%
0.6
%
1.1
%
0.2
%
1 2 3 4 5 6 7 8 andabove
No Resp
FW NFW Overall3
0.1
%
25
.7%
27
.1%
11
.0%
4.1
%
0.7
%
0.3
%
1.0
%
34
.8%
31
.6%
18
.7%
9.6
%
4.8
%
0.5
%
0.0
%
0.0
%
31
.9%
28
.0%
23
.8%
10
.4%
4.4
%
0.6
%
0.2
%
0.6
%
1 2 3 4 5 6 7 8 and above
FW NFW Overall
29
7.1.2 Economic profile of respondents
The range of total reported household monthly income was wide, starting at as low as Rs. 77 and going as high
as Rs. 20,000 (mean: Rs.1869.49) for FW hamlets and starting at Rs. 200 and ranging up to Rs. 30,000 (mean:
Rs.2872.67) for NFW hamlets. Most respondents (FW: 45.5% and NFW: 52.4%) reported a monthly household
income between Rs. 1,000 and 2,000. As many as 24% FW respondents reported a monthly household income
of less than Rs. 1,000 while only 12.3% of the NFW respondents fell under this income bracket. Another 12%
FW and 13.4% NFW respondents reported a monthly HHI between rupees two and three thousand. A t-test
between the FW and NFW monthly HHI values revealed a medium and statistically significant difference with
NFW respondents being economically better off. (Mean values: for FW=1869.49 and for NFW = 2872.67;
P(T<=t) one-tail = 0.007).
However, when considering income data we should take into account inaccuracies inherent in the reported
numbers. There is great difficulty in calculating the monthly household income in an economy where substan-
tial sustenance as well as trading power comes from non-currency transactions using produce from their own
farm or from forest resources. The other key challenges in calculating the income were the uncertainty arising
from seasonality of different kinds of work and multiple sources of income. Also, we encountered some social
hesitation among the respondents in reporting their income. (As many as 9.2% of the women could not, or did
not, provide this information).
The primary source of livelihood for nearly 83% of respondents, both in FW and NFW hamlets, is farming
which is in line with the overall average of 86% for Surguja district (Source - http://surguja.nic.in/areapro-
file.htm). Many respondents reported multiple primary sources of livelihood with another 67.5% FW respond-
ents and 54.5% NFW respondents reporting daily wage work as an important source of livelihood. 80% FW
and72.2% NFW respondents reported at least one family member as being registered for NREGA benefits. A
slightly smaller percentage (FW: 72.3% and NFW: 66.8%) reported actually availing NREGA benefits.
FIGURE 7: TOTAL HOUSEHOLD MONTHLY INCOME
FIGURE 8: HOUSEHOLD'S ACCESS TO AND STATUS OF AVAIL-
ING NREGA BENEFITS
24.0
%
45.5
%
12.0
%
6.5
%
2.1
% 9.9%12
.3%
52.
4%
13.4
%
7.0%
7.0%
8.0%
19.4
%
48.
2%
12.5
%
6.7
%
4.0% 9.
2%
Rs.<1000/-
Rs. 1000-2000
Rs. 2001-3000
Rs. 3001-5000
Rs.>5000/-
No resp
FW NFW Overall
80.1
%
18.8
%
1.0%
72.2
%
26.2
%
1.6%
77
.0%
21.7
%
1.3%
Have Don't have No response
FW NFW Overall
30
FIGURE 9 : HOUSEHOLD'S PRIMARY SOURCE OF LIVELIHOOD
Although the monthly HHI data shows that NFW respondents are economically better off, in terms of Below
Poverty Line (BPL) cards and a BPL ration cards, more NFW respondents have them than FW respondents.
63.4% of the FW respondents and 68.4% of the NFW respondents reported having a BPL Card. However,
both in FW and NFW hamlets, a lower percentage reported having the BPL Ration card (FW: 56.5% and NFW:
62%). Approximately a tenth of the respondents had an APL ration card. Taken together, this would suggest
that all BPL respondents are not necessarily registered as such and thus do not have access to the benefits
available for BPL families (a significant 30.9% do not have a ration card at all).
FIGURE 10: HOUSEHOLD'S BPL CARD STATUS
FIGURE 11: RATION CARD STATUS OF HOUSEHOLDS
7.1.3 Household assets and facilities
More than 90% of the respondents from FW and NFW hamlets live in kutcha houses and a large number of
the respondents, nearly 98% reported living in a house they owned.
83
.2%
67
.5%
2.1
%
0.0
% 7.2
%
0.3
%
0.3
%
82
.9%
54.5
%
7.0
%
0.5
% 9.1
%
0.5
%
0.5
%
83
.1%
62
.4%
4.0
%
0.2
% 7.9%
0.4
%
0.4
%
Farming Daily Work Govt. Job Pvt. Job Self Emp. Others NO Resp.
FW NFW Overall63
.4%
35.3
%
1.4
%
68.4
%
29.4
%
2.1%
65.3
%
33.
0%
1.7%
Have Don't have No response
FW NFW Overall
10.3
%
56.5
%
33.2
%
0.0%
10.2
%
62.0
%
27.
3%
0.5%
10.
2%
58.7
%
30.9
%
0.2%
APL BPL NRC No response
FW NFW Overall
31
FIGURE 12: RESPONDENT DISTRIBUTION BY TYPE OF HOUSE
FIGURE 13: RESPONDENT DISTRIBUTION BY OWNERSHIP OF
HOUSE
The top household asset in terms of ownership is cot, owned by more than 60% of the respondents both in
FW and NFW hamlets. Next in line are wall clock, cycle and mobile phone, owned by more than 50% respond-
ents from FW hamlets and more than 60% respondents from NFW hamlets. Rented out house, bullock cart,
four wheeler and cooler show the lowest (at or below 5%) rate of ownership. Except for radio and ‘own house
with 3 or more rooms’ (where the difference is marginal), all other assets show a higher ownership rate in NFW
households.
TABLE 5: RESPONDENTS' OWNERSHIP OF HOUSEHOLD ASSETS
Household assets FW NFW Overall
Cot 60.3% 69.5% 63.9%
Clock 57.5% 64.7% 60.3%
Cycle 57.9% 62.0% 59.5%
Mobile Phone 50.3% 66.8% 56.8%
More than 2 acre Land 31.8% 43.3% 36.3%
Own house with 3 or more rooms 34.9% 34.2% 34.7%
Fan 16.1% 26.7% 20.3%
Television 15.4% 22.5% 18.2%
Pressure Cooker 12.7% 19.8% 15.4%
Two Wheeler 9.9% 18.7% 13.4%
Radio 11.3% 9.6% 10.6%
Cooler 2.7% 5.3% 3.8%
Four Wheeler 1.0% 4.3% 2.3%
Bullock Cart 1.0% 2.1% 1.5%
Rented out a house with monthly rental of more than Rs. 500/-
0.7% 1.1% 0.8%
95
.5%
2.7
%
0.7
%
0.3
%
0.7
%
93
.6%
4.8
%
0.5
%
0.5
%
0.5
%
94
.8%
3.5
%
0.6
%
0.4
%
0.6
%Kutcha Part. Pukka Pakka Others No response
FW NFW Overall
97
.9%
1.0
%
0.0
%
1.0
%
98
.4%
1.1
%
0.0
%
0.5%
98
.1%
1.0
%
0.0
%
0.8
%
Own house Others Rented No response
FW NFW Overall
32
Nearly 100% of the respondents use wood as the dominant cooking fuel in both kinds of hamlets. 53.4% FW
respondents and 34.8% NFW respondents reported cooking in the same place as where the family sleeps. Given
that wood is the dominant cooking fuel and 89.4% of the respondent households did not have smokeless
chulhas, it indicates a high degree of exposure to smoke which can lead to health issues like respiratory prob-
lems.
FIGURE 14: COOKING FUEL USED
FIGURE 15: PLACE OF COOKING
FIGURE 16: USE OF SMOKELESS CHULHA
FIGURE 17: SOURCE OF DRINKING WATER
In terms of source of drinking water, 55.5% FW respondents and 68.4% of the NFW respondents get water
from a hand pump. While other water sources are the drinking water source most remaining respondents. Only
4.6% of the respondents reported having access to tap water at home.
99
.0%
0.3%
0.0%
1.0%
0.0%
1.0%
99
.5%
0.5%
0.0%
0.0%
0.0% 2.
7%
99
.2%
0.4%
0.0%
0.6%
0.0% 1.7%
Wood Coal Kerosene LPG Biogas Others
FW NFW Overall
53.4
%
45.9
%
0.7%
0.0%
34.8
%
63
.6%
0.5%
1.1%
46.1
%
52.8
%
0.6%
0.4%
Place where thefamily sleeps
Separatecooking space
Outdoors No response
FW NFW Overall
90.1
%
9.6%
0.3
%
88.2
%
10.7
%
1.1%
89.4
%
10.0
%
0.6%
No Yes No response
FW NFW Overall
55.
5%
30.1
%
13.4
%
4.8%
68.4
%
21.9
%
18.2
%
4.3%
60.5
%
26.
9%
15.2
%
4.6
%
Hand pump Others Public tap House tap
FW NFW Overall
33
An important sanitation concern is toilet facilities. 10.6% of the FW and 18.7% of the NFW respondents
reported having toilet facilities at home while a majority i.e. 87.7% FW and 79.7% NFW respondents reported
going out in the open for defecation. In terms of access to electricity, NFW respondents are better off than
FW respondents with 81.3% NFW respondents having electricity supply in their households.
FIGURE 18: TOILET FACILITY AVAILABLE TO RESPONDENTS
FIGURE 19: RESPONDENTS' ACCESS TO ELECTRICITY
Profile of Respondents – Pregnant women
211 pregnant women were interviewed; of these 132 were from FW locations and 79 were from NFW locations.
In FW locations, 65% belonged to scheduled tribes and 22% belonged to other backward classes. In NFW
locations, STs formed 58% of the respondents and 27% respondents belonged to the OBC category.
A majority of the respondents (46% for FW and 42% for NFW locations) are in the 21-25 year age group. A
significant 22% FW respondents and 24% NFW respondents are quite young, aged between 18 to 20 years.
Although just 2% of the pregnant women reported being less than 18 years, they represent a group at risk of
malnourishment and other health issues.
In terms of age at marriage, 37% of FW respondents and 34% of NFW respondents were married before
attaining the legal age of marriage. More than half the respondents, both in FW and NFW hamlets were married
between the age of 18 to 20 years. 35% of the respondents from both locations reported being pregnant for
the first time while for 24% FW respondents and a much higher 38% NFW respondents it was their second
pregnancy. As many as 17% FW respondents and a tenth of NFW respondents reported being pregnant four
or more times. Nearly 39% of the women (40% for FW and 37% for NFW locations) have no children while
12% of the pregnant women from FW locations and 6% from NFW locations reported having 3 or more
children.
In terms of their educational status, nearly half (48%for FW and 49% for NFW locations) of the respondents
were illiterate. The next highest proportions belonged to the 5-7 years of education bracket (13% for FW and
23% for NFW locations) and the 8-9 years bracket (23% for FW and 15% for NFW locations).
87
.7%
10.6
%
1.4%
0.3%
79
.7%
18.7
%
0.5%
1.1%
84
.6%
13.8
%
1.0%
0.6%
Open space Own toilet Public toilet No response
FW NFW Overall
63
.7%
36
.3%
0.0%
81
.3%
18.2
%
0.5%
70
.6%
29
.2%
0.2%
Yes No No response
FW NFW Overall
34
Monthly household income data seems to suggest that respondents from NFW hamlets are better off than
those from FW hamlets. In FW hamlets, 42% women reported a monthly HHI of less than a thousand ru-
pees, 37% reported it to be between Rs.1,000 and 2,000 while only 2% reported a monthly HHI of Rs. 3,000
or more. On the other hand in NFW hamlets, only 23% fall in the lowest income bracket of less than Rs. 1,000,
46% reported a monthly HHI of Rs. 1,000 to 2,000 and 9% reported having a monthly HHI of Rs. 3,000 or
more. In terms of household assets, wall, clock, cot and mobile phones show the highest ownership rates of
60% or more in both FW and NFW locations.
79% of the women from FW and 85% from NFW locations reported farming as their primary source of
livelihood and 71% from FW and 61% from NFW reported that daily wage work was their primary source of
livelihood.
83% of FW and a much lesser 68% of NFW respondents reported that at least one member in the family had
a NREGA card. BPL card status follow a broadly similar trend with 71% FW respondents having one and only
63% NFW respondents having a BPL card. While 69% FW respondents reported having a BPL ration card,
62% had the same in NFW hamlets. Approx. 15% respondents in both kinds of locations did not have a ration
card.
In terms of access to electricity, having a toilet at home and having a separate cooking area, NFW households
seem to be better off than FW households. For details refer to Appendix 1.
In FW hamlets, 13.6% of the pregnant women are in the first trimester (1-3 months) of their pregnancy, 50%
are in the second trimester (4-6 months) and 36.4% reported being in the third trimester (7-9 months) of
pregnancy. In NFW hamlets, 24.1% reported being in the first trimester, 43% in the second and 32.9% in the
third trimester of pregnancy.
35
8 FINDINGS
This section presents the findings from the baseline survey. All findings are discussed for FW and NFW cate-
gories. The findings are discussed under 5 sub-sections,
a) The first subsections discuss findings related to children from birth to three years. They are,
1. Nutritional status of children and possible influencing variables
2. Status of coverage and usage of health and nutrition services for children
3. Status of health and nutrition practices for children
4. Status of psychosocial care practices for children
b) The fifth subsection discusses the status of health and nutrition services and practices for pregnant
and lactating women.
36
Nutritional status of children and possible influencing variables
This section explores the relationship between children’s nutritional status and various influencing variables
especially demographic influencers like gender, mother’s profile and economic condition as signified by house-
hold income and other economic indicators like poverty line status. This is explored using weight to age z-
scores as the basis for comparing prevalence status, running t-tests and generating scatter diagrams to establish
the presence or absence of any relationship and its nature thereof.
The average of weight for age z scores for the overall sample (n-1687) is -1.85. As indicated by the figure below,
the entire population has shifted to the left indicating pervasive malnutrition. A t-test performed on WAZ’s
from the 80 hamlets where FWs had opened and the other 50 where they had not, reveals that, overall, the
difference between the two groups is low and statistically not significant (Mean WAZ for FW hamlets: -1.86,
Mean WAZ for NFW hamlets: - 1.82, P(T<t), one tail = 0.2) . The table below shows that prevalence data for
FW and NFW hamlets is also very similar and doesn’t reveal any noticeable differences. (“Mod. And Sev.”
stands for “Moderate and Severe”, representing the children whose z-score was lower than “-2”).
TABLE 6: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON Z SCORES
Anthropometric indicator WAZ WHZ HAZ
Mod. & Sev.
(<-2SD) Severe
(<-3SD) Mod. & Sev.
(<-2SD) Severe
(<-3SD) Mod. & Sev.
(<-2SD) Severe (<-3SD)
FW (n=1029) 45% 16% 23% 8% 46% 23%
NFW (n=658) 43% 15% 22% 8% 45% 23%
ALL (n=1687) 44% 16% 22% 8% 46% 23%
37
FIGURE 20: OVERALL DISTRIBUTION OF WAZ AGAINST WHO STANDARDS
38
FIGURE 21: OVERALL DISTRIBUTION OF WHZ AGAINST WHO STANDARDS
39
FIGURE 22: OVERALL DISTRIBUTION OF HAZ AGAINST WHO STANDARDS
40
FIGURE 23: DISTRIBUTION OF WAZ AGAINST WHO STANDARDS IN FW HAMLETS
41
FIGURE 24: DISTRIBUTION OF WAZ AGAINST WHO STANDARDS IN NFW HAMLETS
8.1.1 Age
Overall z scores indicate that more than 40% of the children in the age group of 0-3 years are malnourished
(z<-2SD). For FWs, 16.1% of the children fall under the severely malnourished category (z<-3SD) while the
same number for NFWs is marginally lower at 15.2%. Within each age group, (0 to 6 months, 7 to 12 months,
1 to 2 years and 2 to 3 years), more than 40% children are malnourished for both FW and NFW categories.
While in FW hamlets, malnourishment prevalence is more or less uniform across age groups except for slightly
lower prevalence rates for the 7-12 month age group. The only other category that shows any noticeable
variation is the higher prevalence rate of severe malnourishment in the age group of 0-6 months.
In NFW hamlets there is a marked variation across age groups in the prevalence of severe and moderate mal-
nourishment. The prevalence rates are markedly lower for the 7-12 months age group. This is unexplained and
calls for further investigation in order to draw any inference. In the 25-36 months age group, incidence of
severe malnourishment reduces considerably to 9.8%.
42
Table 7 and 8 show no noticeable difference in the prevalence rates of malnourishment in FW and NFW
hamlets across age groups.
Table 7: DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS
Age groups FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
(0-6) 158 15.35% 102 15.50% 260 15.41%
(7-12) 177 17.20% 109 16.57% 286 16.95%
(13-24) 354 34.40% 222 33.74% 576 34.14%
(25-36) 340 33.04% 225 34.19% 565 33.49%
Total (0-36) 1029 100.00% 658 100.00% 1687 100.00%
Table 8: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-FW HAMLETS
Age groups N Mod. & Sev. (< -2SD) Severe (< -3SD) Mean SD
Total (0-36) 1029 45% 16% -1.87 1.17
(0-6) 158 44% 20% -1.91 1.27
(7-12) 177 42% 14% -1.74 1.17
(13-24) 354 47% 16% -1.88 1.21
(25-36) 340 43% 16% -1.90 1.09
TABLE 9: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-NFW HAMLETS
Age groups N Mod. & Sev. (< -2SD) Severe (< -3SD) Mean SD
Total (0-36) 658 43% 15% -1.82 1.16
(0-6) 102 50% 29% -2.09 1.58
(7-12) 109 33% 8% -1.55 1.05
(13-24) 222 45% 18% -1.87 1.17
(25-36) 225 43% 10% -1.79 0.94
TABLE 10: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-OVERALL
Age groups N Mod. & Sev. (< -2SD) Severe (< -3SD) Mean SD
Total (0-36) 1687 44% 16% -1.85 1.17
(0-6) 260 47% 24% -1.98 1.40
(7-12) 286 39% 12% -1.67 1.12
(13-24) 576 46% 17% -1.88 1.19
(25-36) 565 43% 13% -1.86 1.03
43
TABLE 11: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WHZ VALUES
Age groups FW NFW ALL
Moderate (<-2SD)
Severe (<-3SD)
Moderate (<-2SD)
Severe (<-3SD)
Moderate (<-2SD)
Severe (<-3SD)
Total (0-36) 23% 8% 22% 8% 22% 8%
(0-6) 28% 7% 28% 13% 28% 10%
(7-12) 25% 9% 14% 5% 21% 7%
(13-24) 26% 9% 28% 10% 27% 10%
(25-36) 15% 5% 17% 5% 16% 5%
TABLE 12: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND HAZ VALUES
Age groups FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Total (0-36) 46% 23% 45% 23% 46% 23%
(0-6) 34% 12% 38% 20% 36% 15%
(7-12) 31% 17% 34% 16% 32% 17%
(13-24) 46% 26% 46% 23% 46% 25%
(25-36) 59% 29% 54% 27% 57% 28%
8.1.2 Gender
As indicated in the table below, T-tests for FW hamlets show a small but statistically significant difference in
overall z-scores between boys and girls. The differences between them in NFW hamlets are not significant.
Figures below indicate that the entire male and female populations, for both FW and NFW hamlets have shifted
towards the left, indicating pervasive malnutrition across gender and habitation categories.
TABLE 13: DISTRIBUTION OF CHILDREN BASED ON GENDER
Gender FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
Female 547 53.16% 339 51.52% 886 52.52%
Male 482 46.84% 319 48.48% 801 47.48%
Total 1029 100.00% 658 100.00% 1687 100.00%
44
TABLE 14: DISTRIBUTION OF CHILDREN BASED ON GENDER AND AGE
Category FW NFW Overall
Male Female Male Female Male Female
(0-6) 71 87 50 52 121 139
(7-12) 76 101 50 59 126 160
(13-24) 157 197 103 119 260 316
(25-36) 178 162 116 109 294 271
Total (0-36) 482 547 319 339 801 886
FiGURE 25: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS FOR ALL HAMLETS
45
FIGURE 26: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS - FW HAMLETS
46
FIGURE 27: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS - NFW HAMLETS
47
TABLE 15: AGE CATEGORY-WISE GENDER BASED T-TEST OUTPUTS FOR FW AND NFW HAMLETS
Age groups Fulwari Hamlets (n=1029) Non-fulwari Hamlets (n=658)
P value Mean WAZ
male Mean WAZ fe-
male P value Mean WAZ
male Mean WAZ fe-
male
Overall 0.01 -1.96 -1.78 0.17 -1.87 -1.78
0-6 months 0.20 -2.00 -1.83 0.36 -2.14 -2.03
7-12 months 0.07 -1.89 -1.63 0.04 -1.75 -1.38
1-2 years 0.00 -2.08 -1.72 0.16 -1.96 -1.80
2-3 years 0.34 -1.88 -1.92 0.15 -1.73 -1.86
TABLE 16: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND WAZ VALUES
Category FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Female 41% 16% 42% 14% 41% 15%
Male 49% 16% 45% 17% 47% 17%
TABLE 17: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND WHZ VALUES
Category FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Female 20% 7% 23% 7% 21% 7%
Male 25% 8% 21% 8% 23% 8%
TABLE 18: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND HAZ VALUES
Category FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Female 42% 20% 44% 20% 43% 20%
Male 51% 28% 46% 25% 49% 27%
48
8.1.3 Caste category
FIGURE 28: AVERAGE WAZ BY CASTE CATEGORIES
The dominant caste categories are scheduled tribes (FW: 68.5% and NFW: 60.4%) and other backward classes
(FW: 24% and NFW: 29.9%). A t-test on the two demonstrates that for FWs there is a medium and significant
difference in the children’s nutritional status between the two caste categories. (Mean values: for FW STs=--
2.06 and for FW OBCs = -1.78; P(T<=t) one-tail = 0.05).
For NFWs the difference is small and statistically insignificant. (Mean values: for NFW STs=-1.8 and for
NFW OBCs = -1.69; P(T<=t) one-tail = 0.26).
Since the difference between FW and NFW STs is medium, we ran a t-test which reveals that the difference is
also statistically significant. (P(T<=t) one-tail = 0.03).
Table 19: DISTRIBUTION OF RESPONDENTS BASED ON CASTE CATEGORY
Caste Category FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
General 8 2.74% 6 3.21% 14 2.92%
SC 12 4.11% 11 5.88% 23 4.80%
ST 200 68.49% 113 60.43% 313 65.34%
OBC 70 23.97% 56 29.95% 126 26.30%
Others 1 0.34% 0.00% 1 0.21%
Unknown 1 0.34% 1 0.53% 2 0.42%
Total 292 100.00% 187 100.00% 479 100.00%
-2.0
9
-2.0
6 -1.8
2
-1.7
8
-0.4
7
-1.9
8
-1.8
2
-1.8
0
-2.2
4
-1.6
9
-1.7
8
-1.9
7
-1.9
7
-2.0
2 -1.7
4
-0.4
7
-1.9
1
General ST SC OBC Others Total
FW NFW Overall
49
As supported by the table below, for both moderate and severe malnourishment, for STs as well as OBCs,
status of FWs is worse than that of the NFWs.
TABLE 20: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND WAZ VALUES
Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
General 50% 13% 33% 17% 43% 14%
SC 50% 25% 64% 45% 57% 35%
ST 51% 22% 42% 15% 48% 19%
OBC 41% 14% 39% 9% 40% 12%
Others 0% 0% 0% 0% 0% 0%
TABLE 21: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND WHZ VALUES
Caste category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe <-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
General 38% 0% 33% 33% 36% 14%
SC 25% 17% 33% 11% 29% 14%
ST 26% 10% 21% 7% 24% 9%
OBC 21% 9% 15% 4% 18% 7%
Others 0% 0% 0% 0% 0% 0%
TABLE 22: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND HAZ VALUES
Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
General 50% 25% 33% 33% 43% 29%
SC 50% 17% 40% 20% 45% 18%
ST 49% 30% 46% 23% 48% 28%
OBC 44% 18% 55% 19% 49% 18%
Others 0% 0% 0% 0% 0% 0%
8.1.4 Household Income
Scatter diagrams based on the data collected show no relationship between children’s nutritional status and the
household income both for FW and NFW habitation (Figure 21 and 22), even after a small number (FW: 5;
NFW: 12) of severe outliers (incomes over Rs. 6000) were removed. However, as mentioned in the section on
“Profile of Respondents – Mother’s of children Aged 0-3 years”, establishing household income accurately is
problematic and there is no data from nearly 8% of the respondents for both sample populations.
50
FIGURE 29: DISTRIBUTION OF WAZ BASED ON HOUSEHOLD IN-
COME - FULWARI
FIGURE 30: DISTRIBUTION OF WAZ BASED ON HOUSEHOLD IN-
COME - NON FULWARI
Prevalence data shows that there is a sharp fall in the malnourishment status for income levels above Rs. 5,000.
However this doesn’t show up in the scatter diagrams because the numbers of such households are very small
(6 out of 292 in the case of FWs and 31 out of 187 in case of NFWs).
TABLE 23: DISTRIBUTION OF RESPONDENTS BASED ON MONTHLY HHI BRACKET
HHI bracket FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
Rs. <1000/- 70 23.97% 23 12.30% 93 19.42%
Rs. 1000-2000 133 45.55% 98 52.41% 231 48.23%
Rs. 2001-3000 35 11.99% 25 13.37% 60 12.53%
Rs. 3001-5000 19 6.51% 13 6.95% 32 6.68%
Rs. >5000/- 6 2.05% 13 6.95% 19 3.97%
No response 29 9.93% 15 8.02% 44 9.19%
Total 292 100.00% 187 100.00% 479 100.00%
TABLE 24: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND WAZ VALUES
HHI Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<Rs 1000 49% 21% 39% 16% 47% 20%
Rs 1000-2000 49% 19% 49% 18% 49% 19%
Rs 2000-3000 49% 27% 41% 21% 46% 24%
Rs. 3000-5000 48% 12% 32% 6% 41% 10%
>Rs 5000 17% 0% 38% 0% 32% 0%
0
1000
2000
3000
4000
5000
6000
-6 -4 -2 0 2 4
HH income
0
1000
2000
3000
4000
5000
6000
-6 -4 -2 0 2 4
HH income
51
TABLE 25: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND WHZ VALUES
HHI Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<Rs 1000 28% 12% 27% 11% 28% 11%
Rs 1000-2000 22% 9% 18% 4% 20% 7%
Rs 2000-3000 30% 11% 21% 14% 27% 12%
Rs. 3000-5000 22% 5% 10% 3% 17% 4%
>Rs 5000 0% 0% 31% 8% 21% 5%
TABLE 26: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND HAZ VALUES
HHI Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<Rs 1000 44% 24% 36% 8% 42% 20%
Rs 1000-2000 53% 28% 41% 19% 48% 24%
Rs 2000-3000 43% 30% 38% 21% 41% 27%
Rs. 3000-5000 49% 27% 55% 24% 51% 26%
>Rs 5000 50% 33% 46% 23% 47% 26%
8.1.5 Primary source of livelihood
The dominant livelihood groups both for FW and NFW hamlets are farmers (83% for both) and daily wagers
(FW: 67% and NFW: 55%) and a significant number (FW; 53% and NFW: 42%) of respondent households
are sustained by both. All other livelihood groups sustain less than 10% of the population. Thus we ran a t-test
on the two groups which are exclusively sustained by farming (FW: 89 respondents, 30.48%; NFW: 76 respond-
ents, 40.64%) and exclusively sustained by daily wage work (FW: 43 respondents, 14.73%; NFW: 23 respond-
ents, 12.30%).
For the FW hamlets, the t-test shows a small and not significant difference between children’s nutritional status
across the two groups. (Mean values: FW exclusively farmers = -1.964 and exclusively daily wagers = -1.962;
P(T<=t, one-tail = 0.49).
In case of NFW hamlets, the t-test shows a medium and not significant difference between children’s nutritional
status across the two groups. (Mean values: NFW exclusively farmers = -1.84 and exclusively daily wagers =-
1.61; P(T<=t, one-tail = 0.22).
52
FIGURE 31: AVERAGE WAZ BASED ON PRIMARY SOURCE OF LIVELIHOOD
TABLE 27: DISTRIBUTION OF RESPONDENTS BASED ON PRIMARY SOURCE OF LIVELIHOOD
Primary Source of Livelihood
FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
Farming 243 83.22% 155 82.89% 398 83.09%
Daily wage work 197 67.47% 102 54.55% 299 62.42%
Government job 6 2.05% 13 6.95% 19 3.97%
Private job 0 0.00% 1 0.53% 1 0.21%
Self Employed 21 7.19% 17 9.09% 38 7.93%
Others 1 0.34% 1 0.53% 2 0.42%
No response 1 0.34% 1 0.53% 2 0.42%
Total 292 100.00% 187 100.00% 479 100.00%
TABLE 28: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND WAZ VALUES
Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Farming 49% 21% 42% 15% 46% 19%
Daily Wage work 47% 20% 42% 17% 45% 19%
Government Job 50% 0% 15% 0% 26% 0%
Private Job 0% 0% 100% 0% 100% 0%
Self Employed 43% 29% 71% 29% 55% 29%
Others 100% 0% 100% 0% 100% 0%
-2.0
0
-2.0
0
-1.8
5
-1.8
2
-2.9
1
-1.9
8
-1.8
2
-1.7
6 -1.1
8
-2.3
7
-2.4
1
-2.6
0
-1.7
8
-1.9
3
-1.9
2 -1.3
9
-2.3
7
-2.0
8
-2.7
6
-1.9
1
Farming Daily Work Govt. Job Pvt. Job Self Emp. Others Total
FW NFW OVERALL
53
TABLE 29: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND WHZ VALUES
Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Farming 26% 10% 22% 8% 25% 9%
Daily Wage work 25% 10% 24% 9% 25% 10%
Government Job 0% 0% 31% 0% 21% 0%
Private Job 0% 0% 100% 0% 100% 0%
Self Employed 29% 5% 19% 6% 24% 5%
Others 0% 0% 0% 0% 0% 0%
TABLE 30: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND HAZ VALUES
Category FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Farming 49% 28% 42% 21% 46% 26%
Daily Wage work 49% 28% 35% 17% 45% 24%
Government Job 83% 50% 38% 15% 53% 26%
Private Job 0% 0% 0% 0% 0% 0%
Self Employed 52% 33% 69% 38% 59% 35%
Others 100% 0% 100% 0% 100% 0%
8.1.6 Access to NREGA benefits
80% of the respondents in FW hamlets reported
that at least one member in their household is a
NREGA card holder. T-tests between NREGA
card holders and the rest show that the difference
between children’s nutritional status across the two
groups is medium and significant. (Mean Values:
for FW NREGA Card holders = -1.91, for FW
non-NREGA card holders = -2.41; P(T<=t, one-
tail: 0.001)
A t- test between the two groups in NFW hamlets reveals small and statistically insignificant differences. (Mean
Values: for NFW NREGA Card holders = -1.80, for NFW non-NREGA card holders = -1.76; P(T<=t, one-
tail: 0.4)
-2.4
1 -1.9
1
-1.9
8
-1.7
6
-1.8
0
-1.7
8
-2.1
0
-1.8
7
-1.9
1
NO YES Total
FW NFW Overall
FIGURE 32: AVERAGE WAZ BY NREGA CARD STATUS
54
Further, given the large difference in z scores of FW and NFW non-NREGA card holders, a t-test was run
which established a statistically significant difference with the FW non-NREGA card holders being worse off.
(Mean Values: for FW non-NREGA card holders = -2.41, for NFW non-NREGA card holders = -1.76;
P(T<=t, one-tail: 0.03)
TABLE 31: DISTRIBUTION OF RESPONDENTS BASED ON NREGA CARD STATUS
NREGA Card Status FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
Have 234 80.14% 135 72.19% 369 77.04%
Do not have 55 18.84% 49 26.20% 104 21.71%
No response 3 1.03% 3 1.60% 6 1.25%
Total 292 100.00% 187 100.00% 479 100.00%
TABLE 32: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND WAZ VALUES
NREGA card status FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD)
Card Holders 45% 18% 42% 16% 44% 17%
Non-card Holders 65% 29% 45% 14% 56% 22%
TABLE 33: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND WHZ VALUES
NREGA card status FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD)
Card Holders 22% 9% 22% 9% 22% 9%
Non-card Holders 40% 13% 17% 4% 29% 9%
TABLE 34: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND HAZ VALUES
NREGA card status FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD)
Card Holders 45% 26% 44% 23% 44% 25%
Non-card Holders 62% 31% 40% 21% 52% 26%
55
8.1.7 BPL card status
63.4% of the FW respondents reported that they
were BPL card holders. T-tests between BPL card
holders and the rest show that the difference be-
tween children’s nutritional status across the two
groups is small and not significant. (Mean values:
FW BPL cardholders= -1.97 and FW non BPL
cardholders = -2.03; P(T<=t) one-tail = 0.34).
For NFWs, 68.5% respondents reported having
BPL cards. T-tests between BPL card holders and non-BPL card holders reveal a medium and statistically sig-
nificant difference between children’s nutritional status with BPL card holders emerging as the weaker group.
(Mean values: NFW BPL cardholders= -1.89 and NFW non BPL cardholders = -1.57; P(T<=t) one-tail =
0.05).
Further T-tests between the non-BPL card holders of FW and NFW categories reveal medium and significant
differences with the FW group being worse off. (Mean values: for FW non-BPL card holders =-2.03 and for
NFW non-BPL card holders = -1.57; P(T<=t) one-tail = 0.01).
TABLE 35: DISTRIBUTION OF RESPONDENTS BASED ON BPL CARD STATUS
BPL card Status FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
Have 185 63.36% 128 68.45% 313 65.34%
Do not have 103 35.27% 55 29.41% 158 32.99%
No response 4 1.37% 4 2.14% 8 1.67%
Total 292 100.00% 187 100.00% 479 100.00%
TABLE 36: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND WAZ VALUES
BPL card status FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Card Holders 48% 19% 45% 17% 47% 18%
Non-card Holders 50% 21% 36% 11% 45% 18%
-2.0
3
-1.9
7
-1.9
8-1.5
7
-1.8
9
-1.7
8
-1.8
7
-1.9
3
-1.9
1
No Yes Total
FW NFW Overall
FIGURE 33: AVERAGE WAZ BY BPL CARD STATUS
56
TABLE 37: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND WHZ VALUES
BPL card status FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Card Holders 23% 10% 20% 8% 22% 9%
Non-card Holders 29% 9% 21% 6% 26% 8%
TABLE 38: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND HAZ VALUES
BPL card status FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Card Holders 48% 31% 49% 25% 48% 28%
Non-card Holders 49% 20% 28% 17% 41% 19%
8.1.8 Ration card status
FIGURE 34: RATION CARD STATUS WISE AVERAGE WAZ
In NFW locations, the difference between z-scores of APL and BPL card-holders is small and statistically not
significant (mean for APL: -1.61, mean for BPL: -1.88, P(T<t) one-tail: 0.15), as is difference between APL and
no ration card holders (NRCs) (mean for APL: -1.61, mean for NRC: -1.63, P(T<t) one-tail: 0.48) . On the
-1.6
5
-1.9
6
-2.1
2
-1.9
8
-1.6
1
-1.8
8 -1.6
3
-1.7
8
-1.6
3
-1.9
3
-1.9
5
-1.9
1
APL BPL NRC Total
FW NFW Overall
57
other hand, in FW locations, the differences are medium and significant between APL and BPL ration card
holders (mean for APL: -1.65, mean for BPL: -1.96, P(T<t) one-tail: 0.06), as well as between APL and NRC’s
(mean for APL: -1.65, mean for NRC: -2.12, P(T<t) one-tail: 0.01).
TABLE 39: DISTRIBUTION OF RESPONDENTS BASED ON RATION CARD STATUS
Ration card Status FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
APL Ration Card Holders 30 10.27% 19 10.16% 49 10.23%
BPL Ration Card Holders 165 56.51% 116 62.03% 281 58.66%
Non-Ration Card Holders 97 33.22% 51 27.27% 148 30.90%
No response 0 0.00% 1 0.53% 1 0.21%
Total 292 100.00% 187 100.00% 479 100.00%
TABLE 40: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND WAZ VALUES
Ration card status FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
APL Ration Card Holders 30% 20% 47% 11% 37% 16%
BPL Ration Card Holders 47% 18% 44% 18% 46% 18%
Non-Ration Card Holders 57% 22% 37% 10% 50% 18%
TABLE 41: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND WHZ VALUES
Ration card status FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Mod. & Sev.
(<-3SD) Mod. & Sev. (<-2SD)
Severe (<-3SD)
APL Ration Card Holders 23% 13% 26% 11% 24% 12%
BPL Ration Card Holders 23% 9% 19% 9% 21% 9%
Non-Ration Card Holders 29% 9% 20% 2% 26% 6%
TABLE 42: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND HAZ VALUES
Ration card status FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
APL Ration Card Holders 47% 30% 42% 5% 45% 20%
BPL Ration Card Holders 46% 29% 47% 26% 46% 28%
Non-Ration Card Holders 51% 22% 32% 20% 44% 21%
58
8.1.9 Geographical location – the seven blocks
TABLE 43: BLOCK WISE DISTRIBUTION OF RESPONDENTS ACROSS FW AND NFW HAMLETS
Block PW NPW ALL
Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD)
Ambikapur 40% 16% 46% 13% 42% 15%
Batauli 35% 17% 33% 12% 35% 15%
Lakhanpur 41% 8% 44% 19% 43% 14%
Lundra 46% 17% 38% 11% 42% 15%
Mainpath 52% 24% 50% 21% 51% 22%
Sitapur 49% 14% 41% 13% 47% 14%
Udaipur 44% 13% 39% 14% 43% 13%
In the FW group, Lakhanpur has the highest average WAZ and Mainpath has the lowest with the difference
being high. Mainpath demonstrates the lowest average WAZ in the NFW group as well while Batauli has the
highest average WAZ score. Overall children’s nutrition status seems to be the poorest in Mainpath.
FIGURE 35: BLOCK WISE AVERAGE WAZ
-1.7
1
-1.7
2
-1.6
2
-2.0
0
-2.1
5 -1.8
8
-1.8
1
-1.8
7
-1.8
6 -1.5
8
-1.9
2 -1.6
8
-1.9
7
-1.7
7
-1.8
2
-1.8
2
-1.7
7
-1.6
7
-1.7
9
-1.8
6
-2.0
7 -1.8
6
-1.8
2
-1.8
5
Ambikapur Batauli Lakhanpur Lundra Mainpath Sitapur Udaipur Total
FW NFW Overall
59
TABLE 44: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON WAZ VALUES
Block FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD)
Ambikapur 39.89% 16.85% 46.28% 13.22% 42.47% 15.38%
Batauli 35.78% 17.43% 33.33% 11.67% 34.91% 15.38%
Lakhanpur 40.70% 8.14% 44.34% 18.87% 42.71% 14.06%
Lundra 45.51% 17.31% 37.40% 11.38% 41.94% 14.70%
Mainpath 51.96% 24.02% 50.35% 20.57% 51.25% 22.50%
Sitapur 48.73% 13.92% 42.50% 15.00% 47.47% 14.14%
Udaipur 44.71% 13.53% 39.44% 14.08% 43.15% 13.69%
TABLE 45: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON WHZ VALUES
Block FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Ambikapur 19% 4% 18% 2% 19% 4%
Batauli 15% 7% 22% 8% 17% 8%
Lakhanpur 24% 6% 24% 11% 24% 9%
Lundra 27% 5% 20% 8% 24% 6%
Mainpath 33% 16% 27% 12% 30% 14%
Sitapur 19% 6% 15% 0% 18% 5%
Udaipur 24% 13% 27% 14% 24% 13%
TABLE 46: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON HAZ VALUES
Block FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Ambikapur 43% 18% 46% 23% 44% 20%
Batauli 62% 44% 48% 35% 57% 41%
Lakhanpur 38% 17% 56% 31% 48% 25%
Lundra 43% 24% 33% 18% 39% 21%
Mainpath 47% 25% 47% 19% 47% 23%
Sitapur 48% 20% 43% 20% 47% 20%
Udaipur 45% 27% 52% 28% 47% 27%
60
8.1.10 Mother’s profile
This section explores the relationship between children’s nutritional status and the mother’s profile as defined
by her education status, age at the time of marriage and the number of hours she does household or other
work.
8.1.10.1 MOTHER’S EDUCATION STATUS
TABLE 47: DISTRIBUTION OF RESPONDENTS BASED ON EDUCATIONAL PROFILE
No. of years of moth-er's education
FW (n) FW (%) NFW (n) NFW (%) Overall
(n) Overall (%)
Illiterate 157 53.77% 88 47.06% 245 51.15%
1-4 29 9.93% 11 5.88% 40 8.35%
5-7 37 12.67% 32 17.11% 69 14.41%
8-9 45 15.41% 33 17.65% 78 16.28%
10-11 18 6.16% 13 6.95% 31 6.47%
12 and Above 6 2.05% 10 5.35% 16 3.34%
No response 0 0.00% 0 0.00% 0 0.00%
Total 292 100.00% 187 100.00% 479 100.00%
The scatter diagrams (in figure 28 and 29) based on the data collected show no relationship between children’s
nutritional status and the number of years of the mother’s education. While data do show a improvement in
nutritional status of children beyond about 10 years of mother’s education, the number of such mothers is so
small that it does not affect the overall lack of relationship between nutritional status and mother’s years of
education in this district.
61
FIGURE 36: DISTRIBUTION OF WAZ BASED ON MOTHER’S EDUCA-
TION STATUS - FULWARI
FIGURE 37: DISTRIBUTION OF WAZ BASED ON MOTHER’S EDU-
CATION STATUS - NON FULWARI
TABLE 48: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND WAZ VALUES
No. of years of mother's education FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Illiterate 50% 19% 44% 18% 48% 19%
1-4 Years 48% 28% 45% 9% 48% 23%
5-7 Years 54% 22% 31% 13% 43% 17%
8-9 Years 24% 18% 48% 15% 35% 17%
10-11 Years 33% 11% 38% 8% 35% 10%
>=12Years 33% 17% 40% 10% 38% 13%
TABLE 49: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND WHZ VALUES
No. of years of mother's education FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Illiterate 29% 12% 24% 11% 27% 12%
1-4 Years 30% 4% 18% 0% 26% 3%
5-7 Years 14% 6% 13% 6% 13% 6%
8-9 Years 19% 7% 19% 3% 19% 5%
10-11 Years 11% 6% 15% 8% 13% 6%
>=12Years 17% 0% 20% 0% 19% 0%
0
5
10
15
20
-6 -4 -2 0 2
No
. of
year
s o
f m
oth
er'
s e
du
cati
on
0
5
10
15
20
-6 -4 -2 0 2
No
. of
year
s o
f m
oth
er'
s e
du
cati
on
62
TABLE 50: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND HAZ VALUES
No. of years of mother's education FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Illiterate 51% 28% 39% 21% 46% 26%
1-4 Years 36% 25% 45% 36% 38% 28%
5-7 Years 49% 26% 35% 13% 42% 20%
8-9 Years 56% 32% 44% 25% 51% 29%
10-11 Years 22% 11% 67% 33% 40% 20%
>=12Years 50% 33% 50% 20% 50% 25%
8.1.10.2 MOTHER’S AGE AT MARRIAGE
The scatter diagrams (in figure 30 and 31) based on the data collected show no relationship between children’s
nutritional status and mother’s age at the time of marriage.
FIGURE 38: DISTRIBUTION OF WAZ BASED ON MOTHER’S MAR-
RIAGE AGE - FULWARI
FIGURE 39: DISTRIBUTION OF WAZ BASED ON MOTHER’S MAR-
RIAGE AGE - NON FULWARI
TABLE 51: DISTRIBUTION OF RESPONDENTS BY AGE AT MARRIAGE
Mother's age at mar-riage
FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
<18 Yrs 121 41.44% 77 41.18% 198 41.34%
18-20 Yrs 120 41.10% 73 39.04% 193 40.29%
21-25 Yrs 28 9.59% 24 12.83% 52 10.86%
26-30 Yrs 5 1.71% 3 1.60% 8 1.67%
>30 Yrs 1 0.34% 0 0.00% 1 0.21%
No response 17 5.82% 10 5.35% 27 5.64%
Total 292 100.00% 187 100.00% 479 100.00%
0
5
10
15
20
25
30
35
-6 -4 -2 0 2
Mo
the
r's
age
at
mar
riag
e
0
5
10
15
20
25
30
35
-6 -4 -2 0 2
Mo
the
r's
age
at
mar
riag
e
63
TABLE 52: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND WAZ VALUES
Mother's age at marriage FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<18 Years 49% 18% 39% 13% 45% 16%
18-21 Years 47% 21% 41% 13% 44% 18%
22-25 Years 46% 15% 57% 29% 52% 22%
>25 Years 67% 33% 100% 67% 78% 44%
TABLE 53: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND WHZ VALUES
Mother's age at marriage FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<18 Years 28% 11% 21% 7% 25% 10%
18-21 Years 22% 7% 16% 9% 20% 8%
22-25 Years 15% 8% 15% 0% 19% 4%
>25 Years 40% 40% 100% 0% 57% 29%
TABLE 54: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND HAZ VALUES
Mother's age at marriage FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<18 Years 46% 28% 39% 16% 43% 24%
18-21 Years 50% 24% 44% 24% 47% 24%
22-25 Years 46% 38% 62% 8% 54% 23%
>25 Years 67% 33% 0% 0% 44% 22%
8.1.10.3 MATERNAL WORK HOURS
Scatter diagrams (Figure 32 and 33) based on the data available with us indicate that there is no relationship
between children’s nutritional status and the number of hours the mother worked. This data was collected
based on the number of hours the respondent worked on the day before the date of survey. This includes
number of hours spent working on the farm, doing household chores, undertaking any livelihood activities at
or outside home.
64
FIGURE 40: DISTRIBUTION OF WAZ BASED ON MATERNAL WORK-
ING HOURS- FULWARI
FIGURE 41: DISTRIBUTION OF WAZ BASED ON MATERNAL
WORKING HOURS - NON FULWARI
TABLE 55: DISTRIBUTION OF RESPONDENTS BASED ON MATERNAL WORKING HOURS
Maternal working hours
FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
<4 or (blank) 53 18.15% 34 18.18% 87 18.16%
4-8 194 66.44% 128 68.45% 322 67.22%
>8 24 8.22% 15 8.02% 39 8.14%
No response 21 7.19% 10 5.35% 31 6.47%
Grand Total 292 100.00% 187 100.00% 479 100.00%
TABLE 56: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND WAZ VALUES
Maternal working hours FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD) Mod. & Sev.
(<-2SD) Severe (<-
3SD)
<4 Hours 58% 22% 36% 20% 50% 21%
4-8 Hours 44% 18% 45% 13% 44% 16%
>8 Hours 50% 25% 40% 13% 46% 21%
0
2
4
6
8
10
12
-6 -4 -2 0 2
Mat
ern
al w
ork
ing
ho
urs
0
2
4
6
8
10
12
-6 -4 -2 0 2
Mat
ern
al w
ork
ing
ho
urs
65
TABLE 57: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND WHZ VALUES
Maternal working hours FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<4 Hours 32% 10% 29% 14% 31% 12%
4-8 Hours 22% 9% 18% 5% 20% 8%
>8 Hours 30% 9% 14% 7% 24% 8%
TABLE 58: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND HAZ VALUES
Maternal working hours FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
<4 Hours 52% 28% 38% 17% 47% 23%
4-8 Hours 48% 28% 43% 24% 46% 27%
>8 Hours 29% 14% 47% 20% 36% 17%
Status of coverage and usage of health and nutrition services for children
This section discusses the findings regarding the coverage and degree of usage of various health and nutrition
related public services like supplementary nutrition provided by the anganwadi, vaccination and National Health
Insurance Policy.
8.1.11 Supplementary nutrition
In FW hamlets, 71.3% of the respondents (mother’s of 6 month – 3 year olds: n=223), reported going to the
anganwadi in the past week to collect ready-to-eat take-home-ration for their child. Of these, 88% reported that
they received the take home ration.
For the NFW group, these numbers stand at 67.12% women (mother’s of 6 month – 3 year olds: n=146)
reported going o the AW in the previous week of which 90.8% reported that they received the ready-to-eat
take-home-ration.
8.1.12 Vaccination and supplements
Only 61.8% respondents in FW hamlets and 67.8% respondents in NFW hamlets reported having a vaccination
card for their child. However, as high as 95.5% and 96.5% of the mothers of children in the age group 6 months
to 3 years in the FW and NFW groups respectively reported that their child had received some kind of vaccina-
tion. Approx. 95% mothers from both groups reported that their children had been given the polio vaccine
and approx. 94% reported that BCG vaccine had been given. 91.93% children in FW and 89.04% children in
NFW hamlets were reported having received DPT. In FW hamlets 83.16% of the children who were 9 months
or older were reported as having received the anti-measles vaccination. (Measles vaccination is given after 9
months). The same number for NFW hamlets was 80.95%.
66
TABLE 59: STATUS OF VACCINATION OF CHILDREN IN THE AGE GROUP 6-36 MONTHS IN FW AND NFW HAMLETS
Type of vaccination administered BCG Polio DPT
Measles (9 -36 months) Others Don't know
FW 93.72% 95.96% 91.93% 83.16% 3.14% 3.14%
NFW 94.52% 95.21% 89.04% 80.95% 0.00% 1.37%
Overall 94.04% 95.66% 90.79% 82.30% 1.90% 2.44%
When citing reasons for missing any or all of the vaccinations, 20.18% in the FW group and 8.22% in the NFW
group reported a belief that vaccination causes fever. 9.42% of the FW respondents and 7.53% of the NFW
respondents felt that vaccination is not necessary. 3.59% FW respondents and 4.11% of the NFW respondents
could not get their children vaccinated because the vaccination center is too far. 1.79% of FW respondents and
3.42% of NFW respondents said they had no information about vaccination.
70.85% mothers from FW hamlets and 73.29% mothers from NFW hamlets reported that their children had
been given the vitamin A supplement in the last six months. Only 32.29% of the children in FW hamlets were
currently taking iron syrup and the same number for NFW hamlets was much lower at 19.18%. The percentage
of respondents saying that they started the iron syrup only a week prior to the survey is suspiciously large. This
could be attributed to a somewhat elastic definition of time. However, it is also possible that the awareness of
desirable (expected) behaviours has improved in FW locations without the behaviour having necessarily fol-
lowed. This will require further longer-term attention.
TABLE 60: DURATION OF IRON SYRUP INTAKE
Taking iron syrup since < 1 week 1-2 weeks
2-3 weeks
3-4 weeks
> 4 weeks
No re-sponse
FW (n=72: those reported taking iron syrup) 83.33% 6.94% 0.00% 2.78% 2.78% 4.17%
NFW (n=28: those reported taking iron syrup) 60.71% 3.57% 0.00% 3.57% 0.00% 32.14%
Overall 77.00% 6.00% 0.00% 3.00% 2.00% 12.00%
Only 19.51% mothers from the FW group and 15.70% mothers from the NFW group reported that their child
had been given Albendazole (for de-worming) in the last 6 months.
8.1.13 Access to National Health Insurance Program (NHIP)
65.5% of the FW respondents and 58.15% of the NFW respondents reported that they were covered under
the NHIP.
Status of health and nutrition practices for children
This section summarizes the findings for health and nutrition related services. The health and nutrition services
and practices discussed are regarding a) incidence and treatment of common illnesses amongst children and b)
weight monitoring. Nutrition related services and practices are regarding a) breast feeding and weaning and b)
frequency of food intake and food composition.
67
Nutrition related findings are discussed separately for early infancy (0-6 months) as supplementary nutrition
usually starts only after 6 months and thus nutrition practices for them are very different from the rest. A similar
segregation has been followed while discussing incidence and treatment of illnesses.
8.1.14 Health
8.1.14.1 INCIDENCE AND TREATMENT OF COMMON ILLNESSES AMONGST CHILDREN
Data was collected regarding the incidence and treatment practices for three common illnesses, fever, diarrhea
and cold and cough in the two weeks preceding the survey date.
A high incidence of illness is seen amongst children. As indicated by the figures 34 and 35 below, in FW hamlets,
in both the categories of very young infants and children above six months, nearly 60% of the population
reported cold and cough. In NFW hamlets too a high incidence of cold and cough was reported with nearly
half the young infants suffering from cold and as high as 68% of 6-36 months olds reporting the same. Cold
and cough was the most common illness amongst both age groups both in FW and NFW hamlets. However
we should bear in mind that winter rains were experienced during the survey period and thus it is likely that a
higher incidence than usual
FIGURE 42: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -
CHILDREN AGED 0-6 MONTHS
n(FW) = 69; n(NFW)= 41
FIGURE 43: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -CHILDREN AGED 6 MONTHS - 3 YEARS
n(FW) =223; n(NFW)= 146
TABLE 61: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS - CHILDREN AGED 0-6 MONTHS
Illness No. of respondents reporting occurrence of illness in last 15 days
FW NFW Overall
diarrhea 17 9 26
Fever 15 9 24
Cold and cough 42 20 62
Total 69 41 110
25% 22%
61%
22% 22%
49%
24% 22%
56%
Diarrhea Fever Cough & Cold
FW NFW ALL
27%32%
60%
29%
40%
68%
28%35%
63%
Diarrhea Fever Cough & Cold
FW NFW ALL
68
TABLE 62: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -CHILDREN AGED 6 MONTHS - 3 YEARS
Illness No. of respondents reporting occurrence of illness in last 15
days
FW NFW Overall
diarrhea 61 42 103
Fever 71 58 129
Cold and cough 133 100 233
Total 223 146 369
Treatment practices for diarrhea:
This section discusses the reported treatment practices for children suffering from diarrhea in the two weeks
preceding the survey (0-6 months: 25% children in FW and 22% in NFW hamlets and for 6-36 months: 27%
children in FW and 29% children in NFW hamlets.).
For the 0-6 month age group, figures below indicate that as many as 41% mothers in FW hamlets and 33% in
NFW hamlets completely stop the child’s fluid intake. None of the mothers in NFW hamlets follow the rec-
ommended practice of increasing the child’s milk intake during diarrhea. Only 29% of the mothers in FW
hamlets, as recommended, increase the child’s milk intake. None of the mothers of infants under 6 months,
neither in FW nor in NFW hamlets increase the child’s fluid intake during diarrhea. 29% of the mothers from
FW hamlets reported reducing the child’s fluid and milk intake during diarrhea. In NFW hamlets 33% mothers
reduce the child’s fluid intake and 22% reduce the child’s milk intake.
In the 6-36 month category, 10% of the FW respondents increased the child’s fluid intake and 15% increased
the child’s milk intake as recommended. As many as 10% and 52% respondents completely stopped and re-
duced the child’s fluid intake while 21% continued normal fluid intake. 7% and 38% mothers completely
stopped and reduced the child’s milk intake and a third continued to give the child normal levels of milk.
19 and 7% of the mothers of 6-36 months olds in NFW hamlets increased the child’s fluid and milk intake as
recommended. On the other hand, 5 and 10% mothers completely stopped the child’s fluid and milk intake
respectively. 405 of the mothers gave the child lesser fluid and 36% reduced milk intake.
Nearly a third of mothers from FW and NFW reported keeping the child’s milk intake normal.
No data is available for the child’s food intake levels during diarrhea for 30 and 33% of the FW and NFW
respondents respectively. Thus drawing any conclusions on the food intake practices is difficult. However, 39%
FW and 48% NFW respondents reported a reduced food intake which is the recommended practice.
69
FIGURE 44: FLUID INTAKE DURING DIARRHEA - 0-6 MONTHS
FIGURE 45: MILK INTAKE DURING DIARRHEA - 0-6 MONTHS
FIGURE 46: FLUID INTAKE DURING DIARRHEA - 6 MONTHS TO
3 YEARS
FIGURE 47: MILK INTAKE DURING DIARRHEA - 6 MONTHS TO
3 YEARS
FIGURE 48: FOOD INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEAR OLDS
24%29%
0%
41%
6%
33% 33%
0%
33%
0%
27%31%
0%
38%
4%
Normal fluid Less fluid More fluid No fluid No Resp.
FW NFW OVER ALL
41%
29% 29%
0% 0%
78%
22%
0% 0% 0%
54%
27%19%
0% 0%
Normal Milk Less Milk More Milk No Milk No Resp.
FW NFW OVER ALL
21%
52%
10% 10% 7%
31%
40%
19%
5% 5%
25%
48%
14%8% 6%
Normal fluid Less fluid More fluid No fluid No Resp.
FW NFW OVERALL
33%38%
15%7% 8%
36% 36%
7% 10% 12%
34% 37%
12%8% 10%
Normal Milk Less Milk More Milk No Milk No Resp.
FW NFW OVERALL
11%
39%
3%
16%
30%
12%
48%
2% 5%
33%
12%
43%
3%12%
31%
Normal food Less food More food No food No Resp.
FW NFW OVERALL
70
For the 0-6 month’s category, a marked difference is seen between the FW and NFW groups in the practice of
giving the child any rehydration liquid. While 41% FW respondents reported giving the child some rehydration
liquid during diarrhea this number stood at 11% for NFW respondents. In both cases, ORS was the rehydration
fluid given by most mothers.
In FWs, 29% reported seeking the mitanin’s help for the child’s treatment. Another 18% each reported taking
the child to a private and a govt. hospital for treatment of diarrhea. 29% of the respondents reported having
spent Rs.100-500 on the child’s treatment.
22% NFW respondents reported consulting the Mitanin for the child’s treatment. Treatment was sought at
govt. and private hospitals by 11 and 22% or the respondents respectively. 22% of the respondents reported
spending Rs. 100-500 on the child’s treatment.
For more details please refer to appendix 5.
For the 6 month – 3 year category, two thirds of the FW respondents and as high as 57% NFW respondents
shared that they gave the child some kind of rehydrating fluid and out of this 54 and 43% FW and NFW
respondents respectively. The other two rehydration liquids used most frequently (though much lesser than
ORS) were salt and sugar solution and ‘pasiya’ – rice soup.
While a third of the FW respondents reported seeking the Mitanins help for the child’s treatment, only a fifth
of the NFW respondents did the same. 13 and 23% of the FW respondents reported taking the child to a
private or govt hospital respectively for treatment and as many as 7% reported going to a tantric. 11% of the
FW mothers reported spending less than Rs. 100 on the child’s treatment. Another 18 and 10% reported spend-
ing Rs. 100-500 and Rs. 501- 1,000 and a small 2% reported spending between Rs. 1,000-2,000.
19 and 26% NFW respondents took the child to a govt. or private hospital respectively. 5% of the mothers
reported spending less than Rs. 100 and Rs. 501-1,000 on the treatment of diarrhea. As many as a third reported
spending Rs. 100-500 on the child’s treatment while a small 2% reported spending between rupees one and two
thousand.
For more details please refer to appendix 8.
Treatment practices for fever:
This section discusses the treatment practices for fever as reported by mothers of children suffering from fever
(0-6 months: 22% children in FW and NFW hamlets and for 6-36 months: 32% children in FW and 40%
children in NFW hamlets.) in the two weeks preceding the survey date.
For the 0-6 month category as many as 47% of the FW respondents reported that they completely stopped the
child’s fluid intake which is in line with the recommended practice. 20% continued with the usual fluid intake
while a third reported reducing the fluid intake of the child during fever. Only 13% of the respondents reported
increased milk intake by the child, 47% reported normal milk intake and a 40% reported reduced milk intake.
44% of the NFW respondents for the 0-6 month category reported completely stopping the child’s fluid intake
and a third increased the child’s milk intake. These are both recommended practices during fever. Another 44
71
and 11 % mothers continued giving the child normal and reduced fluid intake respectively. 44% mothers re-
ported normal intake by the child and 22% reported a reduced milk intake.
For the 6 month to 3 year category, 24, 30 and 11% FW respondents reported normal fluid, milk and food
intake respectively which are all recommended practices. 58% FW mothers reduced the child’s fluid intake
while 6 and 7% completely stopped and increased the fluid intake respectively. Another 46% mothers reduced
the child’s milk intake while 6% completely stopped the child’s milk intake. 11% of the respondents reported
a higher milk intake by the child. As many as 70% mothers reported reduced food intake by the child during
fever while 13% reported absolutely no food intake by the child.
For NFW hamlets in the 6-36 month category, 10% of the respondents reported increased fluid intake, 33%
reported normal fluid intake while 45% reported a reduced fluid intake of the child during fever. As many as
10% reported completely stopping the child’s fluid intake at this time while 5%and 14% reported absolutely no
milk and food intake respectively. 28% respondents shared that the child’s food intake was normal while a
significant 52% reported reduced food intake by the child. 7% of the respondents reported increased milk
intake of the child, 43% reported normal milk intake and 40% reported reduced milk intake by the child during
fever.
FIGURE 49: FLUID INTAKE DURING FEVER- 0-6 MONTHS
FIGURE 50: MILK INTAKE DURING FEVER- 0-6 MONTHS
20%
33%
0%
47%
0%
44%
11%
0%
44%
0%
29%25%
0%
46%
0%
Normal fluid Less fluid More fluid No fluid No Resp.
FW NFW OVERALL
47%40%
13%
0% 0%
44%
22%
33%
0% 0%
46%
33%
21%
0% 0%
Normal Milk Less Milk More Milk No Milk No Resp.
FW NFW OVERALL
72
FIGURE 51: FLUID INTAKE DURING FEVER- 6 MONTHS TO 3
YEARS
FIGURE 52: MILK INTAKE DURING FEVER- 6 MONTHS TO 3
YEARS
FIGURE 53: FOOD INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS
In the 0-6 month category, FW respondents reported that, as many as one third of the respondents consulted
the Mitanin, 40% went to the govt. hospital for medical help and 13% consulted a private doctor. 7% each
sought help from ‘others’, the ANM or went to a tantric. 42% of the respondents reported having spent
between Rs. 100 to 500 on the child’s treatment. A third of the respondents reported spending Rs. 100-500 on
the child’s treatment while another 13 and 7% reported spending Rs. 501-1,000 and Rs. 1,000-2,000 respec-
tively. 7% also reported spending less than hundred rupees on treatment.
For the NFW category, none of the mothers of 0-6 month olds sought the mitanin’s or ANM’s advice for the
treatment of fever. As many as 44% of the mothers reported going to a private hospital for the child’s treatment
while 22% referred to a govt. hospital. 56% of the respondents reported spending Rs. 100-500 on the child’s
treatment. For more details please refer to appendix 6.
For the 6 months to 3 years category, in case of FW hamlets, a quarter of the mothers consulted the Mitanin
or a govt. Doctor for treatment while just over a third consulted a private doctor. Another 8% went to a
tantric.37% of the respondents spent Rs. 100-500 on the child’s treatment.
24%
58%
7% 6% 7%
33%
45%
10% 10%
0%
28%
52%
9% 8%4%
Normal fluid Less fluid More fluid No fluid No Resp.
FW NFW OVERALL
30%
46%
11%6% 7%
43% 40%
7% 5% 5%
36%43%
9%5% 6%
Normal Milk Less Milk More Milk No Milk No Resp.
FW NFW OVERALL
11%
70%
1%
13%4%
28%
52%
2%
14%5%
19%
62%
2%
13%5%
Normal food Less food More food No food No Resp.
FW NFW OVERALL
73
In NFW hamlets, nearly a third of the mothers of 6-36 months olds reported consulting a private doctor, 22
and 26% respectively sought help from the Mitanin or went to a govt. hospital. A significant 52% of the re-
spondents reported spending between Rs.100 to 500 on the child’s treatment while 7% reported spending less
than Rs. 100. For more details please refer to appendix 9.
Treatment practices for cold and cough:
Cold and cough was found to be the most dominant illness. This section discusses the treatment practices for
cold and cough for the children (0-6 months: 61% children in FW and 49% in NFW hamlets and for 6-36
months: 60% children in FW and 68% children in NFW hamlets.), reported to be suffering from fever in the
two weeks preceding the survey date.
For the 0-6 month category, amongst the FW respondents, just over half of the respondents reported no fluid
intake by the child and a tenth reported increased milk intake by the child during cold and cough. These are
both recommended practices. 24% of the respondents reported a normal fluid intake by the child and 17%
reported reduced fluid intake by the child during cold and cough. The milk intake pattern is very different with
52% reporting normal milk intake and 38% reporting reduced milk intake by the child.
In NFW hamlets, the recommended practice of no fluid intake is followed by 45% of the mothers of 0-6 month
olds and the other recommended practice of increased milk intake was reported by 15% of the mothers. An-
other 35 and 20% of the mothers reported normal and reduced fluid intake respectively. As many as 55% of
the mothers reported normal milk intake by the child while 30% reported reduced milk intake by the child.
In FW hamlets, in the 6-36 months category, in terms of the recommended practices of normal fluid, milk and
food intake, a third of the respondents reported normal fluid intake, just over a third reported normal milk
intake and a quarter reported normal food intake by the child during cold and cough. 47% mothers reported
reduced fluid intake while another 11 and 8 % reported increased and no fluid intake respectively. In terms of
milk, just over a tenth reported completely stopping the child’s milk intake, 35% reported reduced milk intake
while another 16% reported increased milk intake by the child during cold and cough.
For the 6 month to 3 year category, NFW respondents reported a higher compliance with recommended prac-
tices of normal fluid, milk and food intake with 39, 52 and 38% respondents reporting normal fluid, milk and
food intake respectively. A tenth reported increased fluid intake, 41% reported reduced fluid intake and 8%
reported no fluid intake by the child during cold and cough. 5 and 30% reported no and reduced milk intake
respectively while 8% reported increased milk intake. Half of the respondents reported reduced food intake
and a tenth reported completely stopping the child’s food intake during cold and cough.
74
FIGURE 54: FLUID INTAKE DURING COLD AND COUGH- 0-6
MONTHS
FIGURE 55: MILK INTAKE DURING COLD AND COUGH- 0-6
MONTHS
FIGURE 56: FLUID INTAKE DURING COLD AND COUGH - 6
MONTHS TO 3 YEARS
FIGURE 57: MILK INTAKE DURING COLD AND COUGH - 6
MONTHS TO 3 YEARS
24%17%
0%
52%
7%
35%
20%
0%
45%
0%
27%
18%
0%
50%
5%
Normal fluid Less fluid More fluid No fluid No Resp.
FW NFW ALL
52%
38%
10%
0% 0%
55%
30%
15%
0% 0%
53%
35%
11%
0% 0%
Normal Milk Less Milk More Milk No Milk No Resp.
FW NFW ALL
33%
47%
11%8%
3%
39% 41%
10% 8%3%
36%44%
11% 8%3%
Normal fluid Less fluid More fluid No fluid No Resp.
FW NFW OVERALL
35% 35%
16%11%
3%
52%
30%
8% 5% 5%
42%
33%
12%8%
4%
Normal Milk Less Milk More Milk No Milk No Resp.
FW NFW OVERALL
75
FIGURE 58: FOOD INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS
For the 0-6 month category, while a third of the mothers from FW hamlets reported seeking the mitanin’s help;
only 5% did so in NFW hamlets. A tenth of the FW respondents reported going to a govt. Hospital and to a
tantric each while 17% consulted a private doctor. While 12% of the FW respondents spent less than hundred
rupees on the child’s treatment nearly a fifth spent Rs. 100-500. In NFW hamlets, 20 and 35% went to a govt.
And a private hospital respectively while 5% went to a tantric. A fifth of the NFW respondents reported spend-
ing less that Rs. 100 on the child’s treatment, 40% spent Rs. 100-500 while 5% spent between rupees one and
two thousand. For more details please refer to appendix 7.
For the 6 month to 3 year category, in FW hamlets, 29% sought the mitanin’s help and 20% consulted a private
doctor for treating the child’s cold and cough. Another 11% went to a govt. hospital while 5% went to a tantric.
9% of the respondents spent up to Rs. 100 for the child’s treatment and 17% spent between Rs. 100 and Rs.
500. Only a percentage of the respondents reported spending between Rs. 1,000 and 2,000 and spending more
than Rs. 2,000 for the child’s treatment.
For the 6-36 months category, in NFW hamlets, 22 and 26% of the respondents sought the mitanin’s help or
consulted a private doctor respectively. 14% of the respondents went to the govt. hospital. 9% of the respond-
ents reported spending up to Rs.100 for the child’s treatment and 29% spent between Rs. 100 and 500.
Only 1 and 2% reported spending between Rs. 1,000 and 2,000 and spending more than Rs. 2,000 respectively
for the child’s treatment. For more details please refer to appendix 10.
8.1.14.2 WEIGHT MONITORING
For the 0-6 month category, both in FW and NFW hamlets, only 54% of the respondents reported that the
child was weighed immediately after birth. In FW hamlets as many as 29% mothers reported that the child was
not weighed any time soon after the birth. This number stood at 27% for NFW hamlets. In FW hamlets 28%
of the babies were weighed by a nurse, 23% by the Mitanin, 12% by a doctor, 10% by the ANM and 9% by the
AWW. In NFW hamlets, 27% babies were weighed by the nurse. Another 17%were weighed by the ANM,
10% by the doctor and 7% by the AWW. For more details please refer to appendix 11.
In terms of weight monitoring of children from birth to 3 years of age, a marked difference is seen in the levels
of FW and NFW compliance with the recommended practice of weighing the child at least once a month with
FW hamlets reporting higher compliance. While in FW hamlets 73% of the children were weighed in the month
before the survey only 50% were weighed in the NFW hamlets. Out of the children weighed, mothers of 77%
25%
65%
5% 5%2%
38%
50%
0%
10%2%
30%
58%
3%7%
2%
Normal food Less food More food No food No Resp.
FW NFW OVERALL
76
(165 of 215 children) in FW and 75% (70 of 93 children) in NFW hamlets were informed about the child’s
nutritional status. Of the 77% whose nutritional status was reported to the mother in FW hamlets, 76% (125
of 165 children) were reported to be normal and 21% (34 of 165 children) were reported to be malnourished.
In NFW hamlets, out of the 75% children who were weighed and whose nutritional status was shared with the
mother, 83% (58 of 70 children) were reported to be normal and 17% (12 of 70 children) were reported to be
malnourished.
However, this is inconsistent with the findings of this study wherein for 45% (131 children) of the children in
FW hamlets and for 43% (80 children) of the children in NFW hamlets, WAZ was found to be <-2SD. 39%
(49 children) of the 125 children reported to be normal by the mother fall in the moderately or severely mal-
nourished category as per this survey data. In case of NFWs, 36% of the 58 children reported as normal by
mothers fall in the moderately and severely malnourished categories. This calls for understanding whether uni-
form definitions of malnutrition are being used and what are the reasons for variation in this data.
TABLE 63 : STATUS OF CHILDREN’S WEIGHT MONITORING
Weight monitoring activity FW (n=292)
NFW (n=187)
Overall (n=479)
Number Percentage of total of
FW
Number Percentage of total of
NFW
Number Percentage of total
Weighed in the last month 215 73% 93 50% 308 64%
Mother informed about the child’s nutritional status
165 56% 70 38% 232 48%
Children reported normal 125 42% 58 31% 183 38%
Of these, children se-verely malnourished as per survey data (WAZ<-3 SD)
17 6% 5 3% 22 5%
Of these, children moderately malnour-ished as per survey data (WAZ<-2 SD & > -3 SD)
32 11% 16 9% 48 10%
Children reported malnour-ished
34 11% 12 6% 46 9.50%
8.1.15 Nutrition
8.1.15.1 BREAST FEEDING AND WEANING PRACTICES
Interviews with mothers of 0-6 month olds revealed that 99% of the children in FW hamlets and 98% children
in NFW hamlets are breastfed. Also 86 and 85% of the children in FW and NFW hamlets respectively were
77
given colostrum. Just over a quarter of the children in FW hamlets were reported being fed for the first time
only later than 6 hours after birth. This number is much lower for NFW hamlets at 9%.
Also 25% of the FW respondents and 12% of the NFW respondents reported that the child was given some-
thing other than the mother’s milk within the first three days of birth. For most of these infants, they were
given some other milk than the mother’s milk. 22 and 15% of FW and NFW respondents respectively, also
reported giving the child something other than mother’s milk in the last one month. For more details please
refer to appendix 12.
Based on responses of mothers of children aged 6 months to 3 years, complementary nutrition was started for
65% children in FW hamlets and 68% children in NFW hamlets after the child was 6 months old.
FIGURE 59: TIME OF FIRST BREAST FEEDING OF A NEWBORN
61%
13%9%
6% 4% 4% 3%
71%
20%
2%0%
7%
0% 0%
65%
15%
6%4% 5%
3% 2%
within 0-1 hour within 1-6 hours within 6-12 hours within 12-24hours
after than 24hours
Don't remember No Resp.
FW NFW Overall
78
FIGURE 60: STATUS OF COLOSTRUM BEING GIVEN TO NEW-BORNS
FIGURE 61: INFANTS AGED 0-6 MONTHS - GIVEN FOOD
OTHER THAN MOTHER'S MILK IN LAST 1 MONTH
FIGURE 62: INFANTS AGED 0-6 MONTHS BEING BREASTFED
BY MOTHER
FIGURE 63: TIME OF STARTING COMPLEMENTARY NUTIRTION
8.1.15.2 FREQUENCY OF FOOD INTAKE AND FOOD COMPOSITION
The findings of this section are based on responses regarding the food intake of children aged 6 months to 3
years on the day prior to the survey date. 13 and 19% of the children in FW and NFW hamlets respectively
were reported as eating less than the recommended three meals a day. Most children (32% in FW and 27% in
NFW hamlets) ate thrice a day. Another 27% children from FW hamlets and 23% children from NFW hamlets
hate four times a day.
86%
13%
1%
85%
15%
0%
85%
14%
1%
YES NO No Resp.
FW NFW Overall
22%
78%
15%
85%
19%
81%
YES NO
FW NFW Overall
99%
1%
98%
2%
98%
2%
YES NO
FW NFW Overall
33%
65%
2%
25%
68%
8%
30%
66%
4%
Before 6 Months After 6 Months Not Yet Started
FW NFW Overall
79
FIGURE 64: FREQUENCY OF EATING - CHILDREN AGED 6 MONTHS - 3 YEARS
53% mothers in FW hamlets and 70% mothers from NFW hamlets reported that they did not add oil to the
child’s food at all. 31% parents from FW and 12% parents from NFW hamlets reported adding oil to the
child’s food twice or more which is in line with the recommended practice of adding oil to the child’s food at
least twice a day.
FIGURE 65: FREQUENCY OF ADDING OIL TO FOOD - CHILDREN AGED 6 MONTHS - 3 YEARS
A look at the composition of the food intake of 6 -36 month olds shows that rice is the most dominant com-
ponent of their diet with 78% in FW hamlets and 66% in NFW hamlets reporting eating rice more than twice
a day. Pulses, green vegetables and potatoes seem to form the next dominant component of the children’s diet.
3%
10
%
32
%
27
%
15
%
9%
3%
2%4
%
15
%
27
%
23
%
16
%
5%
2%
7%
4%
12
%
30
%
25
%
16
%
7%
2% 4%
Once Twice Thrice Four Times Five Times Six Times Seven orMoretimes
No Resp.
FW NFW Overall1
2% 16
%
9%
3%
2%
0% 1%
53
%
4%
12
%
8%
2%
1%
1%
0% 1%
70
%
7%1
2%
13
%
7%
2%
1%
0% 1%
60
%
5%
Once Twice Thrice Four Times Five Times Six Times Seven or Moretimes
Not at all No response
FW NFW Overall
80
Yet more than 40% children in FW hamlets do not get green vegetables of potatoes while 52and 47% children
in NFW hamlets do not get green vegetable and potatoes respectively. There is a marked difference between
FW and NFW hamlets in terms of children’s consumption of dal with 76% FW children consuming dal at least
once a day and only 60% children doing so in NFW hamlets. While 22% FW children from FW hamlets re-
ported consuming eggs, only 4% reported the same from NFW hamlets. More than 90% of the children were
reported not consuming meat, fish, milk/curd and fruits.
TABLE 64: FOOD COMPOSITION - CHILDREN 6 MONTHS - 3 YEARS
Food Once Twice More than Twice Not at all
FW NFW FW NFW FW NFW FW NFW
Rice 2% 6% 13% 21% 78% 66% 7% 7%
Dal 17% 21% 23% 23% 36% 16% 24% 40%
Green Vegetable 20% 15% 17% 16% 21% 17% 42% 52%
Potatoes 24% 17% 15% 21% 18% 15% 43% 47%
Other Vegetables 13% 14% 6% 6% 3% 5% 78% 74%
Egg 17% 4% 4% 0% 1% 0% 77% 96%
Meat 2% 3% 1% 1% 0% 0% 97% 96%
Fish 3% 1% 0% 0% 0% 0% 97% 99%
Milk / Curd 2% 3% 2% 1% 3% 0% 93% 95%
Fruits 3% 4% 2% 1% 1% 0% 94% 95%
8.1.16 Kitchen Gardens
Approximately 97% of the respondents, both from FW and NFW hamlets reported having a kitchen garden in
at least one of the seasons (winter/ monsoon/ summer).
Table 65: PREVALENCE OF KITCHEN GARDENS
Kitchen garden FW (n) FW (%) NFW (n) NFW (%) Overall (n) Overall (%)
Don’t have 9 3.08% 6 3.21% 15 3.13%
1 season 154 52.74% 94 50.27% 248 51.77%
2 seasons 33 11.30% 35 18.72% 68 14.20%
3 seasons 96 32.88% 52 27.81% 148 30.90%
Have at least in 1 season 283 96.92% 181 96.79% 464 96.87%
Total 292 100.00% 187 100.00% 479 100.00%
FIGURE 66: AVERAGE WAZ BY KITCHEN GARDEN STATUS
81
Average WAZ is lowest for the respondents who do not
have kitchen gardens at all (FW = -2.04 and NFW = -
2.27). However the sample size (FW = 9 and NFW = 6)
is too small to draw any meaningful conclusions. Differ-
ences between average WAZ of other categories (kitchen
gardens in one, two or three seasons) is small or medium.
TABLE 66 PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND WAZ VALUES
Kitchen garden status
FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Not at all 56% 11% 33% 33% 47% 20%
1 season 55% 19% 41% 14% 50% 17%
2 seasons 30% 15% 40% 20% 35% 18%
3 seasons 42% 22% 46% 12% 43% 18%
TABLE 67: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND WHZ VALUES
Kitchen garden status
FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Not at all 33.33% 22.22% 50.00% 50.00% 40.00% 33.33%
1 season 23.38% 9.74% 20.21% 6.38% 22.18% 8.47%
2 seasons 21.21% 9.09% 22.86% 14.29% 22.06% 11.76%
3 seasons 28.13% 10.42% 21.15% 9.62% 25.68% 10.14%
TABLE 68: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND HAZ VALUES
Kitchen garden status
FW NFW ALL
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Not at all 22.22% 22.22% 33.33% 16.67% 26.67% 20.00%
1 season 49.35% 29.22% 45.74% 29.79% 47.98% 29.44%
2 seasons 60.61% 30.30% 25.71% 11.43% 42.65% 20.59%
3 seasons 45.83% 27.08% 48.08% 19.23% 46.62% 24.32%
-2.0
4
-2.0
4
-1.7
7
-1.9
6
-1.9
8
-2.2
7 -1.7
6
-1.8
5
-1.7
2
-1.7
8
-2.1
3
-1.9
4
-1.8
1
-1.8
7
-1.9
1
Not at all 1 season 2 seasons 3 seasons Overall
FW NFW Overall
82
83
Status of psychosocial care practices for children
To understand the nature of psychosocial care being received by the child, the most and least common practices
of spending time with the child were extracted for each age group.
TABLE 69: PSYCHOSOCIAL STIMULATION DURING BATHING TIME
Bathing Time
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
25% 24% Sing songs while bathing the child 11% 11%
While bathing, let the child pour water on his / her own 27% 40%
Ask the names of different body parts 23% 24%
Let the child dress and comb on his / her own
26% 34%
Bathing the baby with older children in the family 29% 33%
Give the child various things to play with while bathing 29% 36%
Name things like mug, wa-ter, bucket 24% 48%
Give the child various things to play with while bathing
86% 85% Talk while mas-saging the baby 42% 28%
Talk to the child like name various body parts 37% 28%
Apply soap on her own 35% 42%
Let the child play in water
39% 43% Let the child hold the mug 34% 44%
Allow to play in water 37% 36%
Give the child time to bathe on his/ her own
42% 35% Let the child play in water 39% 60%
Give toys to play in water 41% 50%
Apply soap on her own
62% 68% Talk to the child 76% 82%
Be with the child when s/he is bath-ing
73% 82% Be with the child 90% 88%
Talk to the child while bathing him / her
Both for FW and NFW hamlets, the table above indicates a high score for activities ‘talking to the child’ for
the youngest and the oldest age group and a moderate score for the two age groups in the middle. There is also
a clear high score for ‘being present while the child is bathing’ for children between 1 to 2 and 2 to 3 years.
While there is clear evidence that mothers themselves are present while bathing the children and that there is
some talk, the quality of the talk seems to remain at a basic or functional level. For instance, more complex
conversations which are necessary for cognitive stimulation, like ‘talking about parts of the body’ or ‘naming
things around’ received a low or moderate score. Similarly, other cognitively stimulating activities, like ‘playing
with water or toys’ during bathing or ‘encouraging independent pouring of water, applying soap’ received mod-
erate scores. The table also indicates that active stimulation during bathing is made available more for the last
two older age groups.
84
TABLE 70: PSYCHOSOCIAL STIMULATION DURING MEAL TIME
Meal Times
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
28% 27%
Hum while breastfeed-ing the child 41% 30%
Talk to the child while cooking 24% 34% Wean 18% 12%
Teach the child how to serve food
59% 71% Talk to the child 59% 35%
Let the child hold eata-bles 33% 36%
Ask the child about her food prefer-ences 28% 26%
Take the child's help while prepar-ing for meals
78% 71% Caress the child 55% 65%
Eat with the entire family at least once a day 56% 56%
Talk to the child like what's for lunch today 37% 56%
Ask for the child's food preferences
84% 78% Look at the child 80% 78%
Talk to the child while feeding him / her 58% 70%
Eat with the entire family at least once a day 41% 54%
Encourage the child to name and ask for various foods / food items
72% 74%
Encourage the child to eat on her own 41% 50%
Talk to the child like what's there for dinner
45% 56%
Teach the child how to break bread and eat with dal / vege-tables
60% 76%
Eat with the entire family at least once a day
85% 92%
Encourage the child to eat on his / her own
The scores for ‘meal times’ across FW and NFW hamlets show a largely similar trend as well. During meal
times interestingly, talking to the child had a high score in the first two age groups, and the score reduced to a
moderate level in the subsequent two age groups. Like at bathing time, during meal times as well more complex
conversations necessary for cognitive development like “what’s for dinner’ have a moderate score only. Simi-
larly, other activities for stimulating the child’s cognitive development like ‘taking the child’s help in the kitchen’,
received a low score. Correspondingly, in the later two age groups, independent eating had a high score. It may
imply that as the child begins to feed him/herself more independently, active conversation or engagement with
the child reduces. However, in both the higher age groups, the practice of eating together does prevail and gets
a moderate and high score.
85
TABLE 71: PSYCHOSOCIAL STIMULATION DURING SLEEP TIME
Sleep Time
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
32% 39% Sing lullabies 45% 41% Sing lullabies 19% 24%
Asking the child about her day 13% 6%
Getting the child into the habit of brush-ing before sleeping
38% 34% Play for some-time 56% 63%
Play for some-time 41% 50% Sing lullabies 13% 14%
Taking the child's help in making the bed
54% 56% Talk to the child 83% 91%
Sleep next to the child 46% 40% Tell stories 23% 26% Sing lullabies
97% 85% Sleep next to the baby 46% 44%
Get the child used to being put to sleep by various family mem-bers 23% 36%
Asking the child about her day
81% 90%
Put the baby to sleep in a safe place 70% 70%
Play with the child for sometime 45% 54%
Listen to the child's stories
51% 56%
Get the child used to being put to sleep by various family members
60% 76% Play with the child
Activities around sleep time reveal that singing to the children is not a very common activity as it was low or
moderate in the first three age groups and low in the last age group. However, playing with the child was
reported as an activity adopted by many mothers and thus gets a high score in the last two age groups and
moderate in the first and second age groups. Talk and stories were at a moderate score. In the first two age
groups, the practice of sleeping next to the child is common and shows high scores.
86
TABLE 72: PSYCHOSOCIAL STIMULATION DURING FREE TIME
Free Time
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
19% 29%
Use differ-ent voices and sounds while talking to the child 30% 26%
Respond to the sounds made by the child 30% 36%
Encourage the child to mimic others 21% 18%
Let the child re-peat songs after you
26% 29% Sing to the child 45% 30%
Play peek-a-boo with the child 49% 60%
Play hide and seek 26% 26%
Let the child imi-tate sounds of fa-miliar animals and talk about them
28% 41%
Encourage the child to hold your finger 39% 41%
Let the child play with and touch pets 51% 38%
Let them play with and touch pets 47% 38%
Take the child's help in small chores like get a glass of water
32% 34% Make differ-ent sounds 42% 48%
Make differ-ent sounds 66% 68%
Talk while play-ing 53% 52%
Play hide and seek
42% 49%
Play with the child with a rattle and talk to the child 67% 65%
Take the child outdoors and point out vari-ous things like flowers, but-terflies etc. 73% 82%
Take the child outdoors and point out vari-ous things to the child 54% 64%
Encourage the child to play with other children his / her age
54% 56% Tickle the child 68% 61%
Call the child by his / her name 73% 90%
Take the child to visit neigh-bours and en-courage her to talk to every-one 64% 76%
Take the child to visit neighbours and encourage her to talk to everyone
68% 56%
Do exercises for arms and legs 64% 72%
Talk to the child while playing with him / her 69% 80%
Talk while play-ing
77% 78%
Take the child outdoors and point out various things to the child
Again, similar scores were reported for FW and NFW hamlets. The above table indicates that not many mothers
of the youngest infants spend their free time with their child, whereas as the child grows older, a high percentage
of mothers reported ‘taking the child out and showing things’ or ‘encouraging the child to talk to neighbours’
in the older two age groups. Majority of them also referred to talking to the child while playing during free
time. However, several forms of simple play like ‘making sounds’ , ‘hide and seek’ etc were reported only by a
moderate number of parents.
87
TABLE 73: PSYCHOSOCIAL STIMULATION DURING TOY TIME
Toys
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
23% 22% Make a doll for the baby 27% 30%
Make a doll for the child 23% 22%
Play games in-volving jump-ing 26% 32%
Give the child lock and keys to play with
35% 24% Rattle 41% 54% make a ball for the child 29% 32%
Play with lock and key 31% 46%
Make a mud house in a cor-ner of the house and give him / her old house-hold things to play with
42% 32% Make a ball for the baby 47% 48% Utensils 35% 58%
Organize uten-sils one inside the other 42% 58%
Organize uten-sils one inside the other
36% 34%
Toys that make different sounds 53% 48%
Toys that make different sounds 42% 52%
Let children play in the mud / sand with ob-jects like bot-tles, boxes, sieves etc. 44% 56%
Show picture books and talk to the child
43% 46%
Put in and take out objects from a basket 50% 52%
Play games that involve running and jumping
44% 32%
Buy toys which have to be pulled 53% 56%
Give the child empty bottles and boxes to play in the mud near the house.
63% 64%
Give plastic bottles to open and close the bottle cap
The table indicates no high score in any age group, neither for FW nor for NFW hamlets. However, a wide
range of ‘makeshift’ toys receive a moderate score across all age groups. Creative and stimulating toys are
clearly missing across all age group.
Health and nutrition services and practices for pregnant and lactating women
The section discusses the status of health and nutrition services and practices for pregnant and lactating women.
As mentioned earlier, 211 pregnant women (132 from FW and 79 from NFW hamlets) were interviewed and
mothers of infants aged 0-6 months (n=110, 69 from FW and 41 from NFW hamlets) have been considered
for the lactating women section. Ante natal care services, post natal care services, institutional delivery and
nutritional practices for lactating women have been discussed under this section. While more services and prac-
tices for pregnant women have been discussed here like number of hours they work, do they register the preg-
nancy or not etc.
88
8.1.17 Health and nutrition services:
8.1.17.1 REGISTERING THE PREGNANCY
81% of the pregnant women from FW hamlets and 87% from NFW hamlets reported have registered this
pregnancy. In FW hamlets, 52% of the women reported consulting the Mitanin confirmation of the pregnancy,
31% consulted the anganwadi worker, 10% consulted a doctor and 8% consulted a nurse while no data is
available for 9% of the respondents. In NFW hamlets, a much lesser proportion of women; 38% only consulted
the Mitanin for confirming this pregnancy, while 30% consulted the anganwadi worker and 14% consulted a
doctor. For more details refer to appendix 2.
8.1.17.2 ANTE NATAL CARE (ANC) SERVICES
43% of the pregnant women from FW hamlets and 38.6% from NFW hamlets reported not having undergone
a single ANC till now. Since 25% of lactating women from FW hamlets and 20% from NFW hamlets gave no
response it is difficult to comment on the status of lactating women’s access to and usage of ANC checkups.
For more details please refer to appendix 2.
A look at the ANC services availed by pregnant women shows that tetanus injection was the most availed
service with 75% pregnant women from FW hamlets and 82% from NFW hamlets receiving it. Next in line
was intake of iron tablets wherein 71% pregnant women from FW hamlets sand 73% from NFW hamlets
reported taking iron tablets. Of these more than 10% respondents from FW and NFW hamlets did not respond
to how many iron tablets they had taken till now and thus it is difficult to comment on this aspect. However
from available data, although nearly a third of pregnant women in FW and NFW hamlets reported being in the
third trimester of their pregnancy, only 3 and 1% FW and NFW respondents respectively reported taking the
advised dosage of more than 100 iron tablets. 17% from FW hamlets reported taking the iron syrup and 14%
from NFW reported the same. The only other service availed by more than 70% women is weight monitoring
by pregnant women from NFW hamlets. All other services were availed by approximately 50% r lesser women.
Amongst lactating women as well, intake of iron tablets and tetanus injection are the most availed services with
more than 70% women availing the service. Weight monitoring is the next most availed service with 72% FW
respondents and 63% NFW respondents availing it. All other services were availed by nearly 50% or lesser
women with abdominal examination being the least availed service. For more details refer to appendix 2.
TABLE 74: STATUS OF USAGE OF ANC SERVICES BY LACTATING MOTHERS AND PREGNANT WOMEN
ANC service availed Pregnant women Lactating mothers
FW NFW FW NFW
Pregnancy test 51% 51% 55% 46%
Weight monitoring 59% 73% 72% 63%
Measure Blood pressure 39% 43% 30% 49%
Urine test 44% 49% 42% 49%
Blood test 47% 56% 54% 63%
Abdominal examination 38% 56% 29% 37%
Iron tablets 71% 73% 70% 83%
Tetanus injection 75% 82% 81% 90%
No response 13% 5% 10% 5%
89
Most women (23% from FW and 48% from NFW hamlets), were motivated for an ANC check-up by the
Mitanin. Other key influencers, motivating more than 10% of women each for the ANC check up were the
anganwadi worker and the women’s mother-in-law and husband. In FW hamlets most (more than 20% each)
ANC checkups were conducted by the Nurse/ANM and the doctor while 14% women went to a private doctor
for their ANC check-up. In NFW hamlets 30% of the ANC checkups were conducted by a govt. Doctor while
more than 10% respondents reported that their ANC check-up was conducted by a nurse/ANM and a private
doctor.
40.9% of the pregnant women from FW hamlets and 35.4% from NFW hamlets reported that they had received
advice on possible complications that could arise during the pregnancy while data was not available for nearly
9% of the respondents.
8.1.17.3 INSTITUTIONAL DELIVERY
Only 4% lactating women from FW and 7% from NFW hamlets reported that their last delivery was a caesar-
ean. 57% of the lactating mothers from FW hamlets and 63% from NFW hamlets reported that their last
delivery was an institutional delivery i.e. they delivered in a government. or a private hospital. A very small
proportion (1% form FW hamlets and 5% from NFW hamlets) reported having assisted home based deliveries
i.e. they delivered at home with the assistance of a doctor or an ANM. As many as 42% respondents from FW
hamlets and 32% from NFW hamlets reported having home-based-unassisted deliveries.
56% of the pregnant women from FW hamlets said they were planning institutional deliveries while two thirds
said the same from NFW hamlets. 38.6% from FW hamlets and 26.5% from NFW hamlets were yet to decide
and 3.5% from FW and 5% from NFW hamlets were not planning institutional deliveries. In FW hamlets the
biggest reason (5% respondents) for not choosing institutional delivery was that the distance to the medical
facility was prohibitive. Another 3% cited cultural issues and ‘other’ reasons while 2% said it was too expensive.
These numbers for NFW hamlets were even smaller.
Table 75: TYPE OF DELIVERY - LACTATING WOMEN / MOTHERS OF 0-6 MONTHS OLDS
Type of delivery FW (n) FW (%) NFW (n) NFW (%) All (n) All (%)
Institutional (in hospital) 39 57% 26 63% 65 59%
Assisted home based delivery (when delivery at home assisted by doctor or ANM
1 1% 2 5% 3 3%
Home based delivery without medical assis-tance
29 42% 13 32% 42 38%
Total 69 100% 41 100% 110 100%
90
TABLE 76: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WAZ VALUES
Type of delivery FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Institutional de-livery
46% 26% 46% 27% 46% 26%
Assisted home based deliveries
100% 0% 0% 0% 33% 0%
Unassisted home based deliveries
48% 17% 46% 31% 48% 21%
TABLE 77: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WHZ VALUES
Type of delivery FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Institutional de-livery
11% 6% 25% 8% 17% 7%
Assisted home based deliveries
0% 0% 0% 0% 0% 0%
Unassisted home based deliveries
31% 3% 25% 8% 29% 5%
TABLE 78: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND HAZ VALUES
Type of delivery FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Institutional de-livery
47% 18% 52% 20% 49% 19%
Assisted home based deliveries
0% 0% 0% 50% 0% 33%
Unassisted home based deliveries
34% 17% 31% 23% 33% 19%
8.1.17.4 POST PARTUM CARE (PPC) SERVICES
Just over 20% of the lactating women from both FW and NFW hamlets reported having undergone a PPC
check-up within a month of their last delivery. In FW hamlets, 9% reported undergoing one PPC check up and
13% reported undergoing more than one PPC check-up. For NFW hamlets, 15% underwent one PPC check-
up and 10% underwent more than one PPC check-up. PPC checkups were conducted by a doctor for approx.
20% of the women in FW and NFW hamlets. 17% women from FW hamlets and 15% from NFW hamlets
underwent the PPC check-up at the government hospital. 45% lactating women from FW hamlets and 20%
91
from FW hamlets reported that they faced health problems after their last delivery. For details please refer to
appendix 2.
8.1.17.5 SUPPLEMENTARY NUTRITION
More than 80% of the pregnant women from FW and NFW hamlets reported being registered at the anganwadi
and approx. 68% from both FW and NFW reported visiting the anganwadi in the week prior to the survey.
Out of the 68% women (91 from FW and 54 from NFW) who visited the anganwadi in the previous week,
72.5% (66) from FW hamlets and 83.33% (45) reported receiving the ready-to-eat take-home-ration. Thus only
50% of the total FW respondents and 57% of the total NFW respondents received the ready-to-eat take-home-
ration.
8.1.17.6 ACCESS TO NATIONAL HEALTH INSURANCE PROGRAM
61.36% of the pregnant women from FW hamlets and 60.76% from NFW hamlets reported that they were
covered under the National Health Insurance Program.
8.1.18 Practices: Health and nutrition
8.1.18.1 NUTRITION
The findings of this section are based on responses regarding the food intake of lactating mothers and pregnant
women on the day prior to the survey date.
As was the case for children aged 6 – 36 months, for pregnant women also, rice is the most dominant compo-
nent of their daily diet followed by pulses, green vegetables and potatoes. The consumption of pulses, green
vegetables and pulses was low with these not being available to almost 30-50% of the respondents. Also as seen
in case of 6-36 months category of children, dal was consumed by markedly more women in FW hamlets (72%)
than in NFW hamlets (56%) and the same is true for consumption of eggs wherein 17% of pregnant women
in FW hamlets consumed egg, only 4% reported the same from NFW hamlets. In both groups, more than 90%
of the women reported no intake of meat, fish, milk/curd and fruits.
TABLE 79: FOOD COMPOSITION - PREGNANT WOMEN
Food Once Twice More than Twice Not at all
FW NFW FW NFW FW NFW FW NFW
Rice 6% 1% 37% 53% 55% 43% 2% 3%
Dal 25% 25% 27% 19% 20% 11% 28% 44%
Green Vegetable 27% 14% 25% 37% 18% 11% 30% 38%
Potatoes 20% 29% 20% 22% 10% 6% 50% 43%
Other Vegetables 14% 16% 4% 6% 1% 1% 81% 76%
Egg 14% 3% 2% 1% 0% 0% 83% 96%
Meat 3% 5% 0% 0% 0% 0% 97% 95%
Fish 4% 6% 0% 0% 1% 0% 95% 94%
Milk / Curd 4% 3% 2% 0% 0% 0% 95% 97%
Fruits 8% 4% 3% 3% 0% 0% 89% 94%
92
A similar trend is revealed by data on food consumption by lactating women. Rice was reported to be consumed
by 84% women from FW hamlets and 66% from NFW hamlets. Pulses, green vegetable and potatoes were not
available to 40 to 70% lactating women in both FW and NFW hamlets with the numbers being worse for NFW
hamlets for all three. Approx. 80% women did not have any other vegetables and 93% did not have eggs as a
part of their meals. While in FW hamlets, more than 90% women did not consume meat, fish, milk/curd and
fruits, the same number for NFW hamlets was 100%.
TABLE 80: FOOD COMPOSITION - LACTATING MOTHERS
Food Once Twice More than twice Not at all
FW NFW FW NFW FW NFW FW NFW
Rice 7% 7% 32% 27% 45% 32% 16% 34%
Dal 26% 22% 17% 15% 14% 2% 42% 61%
Green Vegetable 22% 15% 20% 17% 10% 2% 48% 66%
Potatoes 25% 22% 13% 10% 4% 2% 58% 66%
Other Vegetables 12% 7% 7% 10% 0% 2% 81% 80%
Egg 6% 7% 1% 0% 0% 0% 93% 93%
Meat 6% 0% 1% 0% 0% 0% 93% 100%
Fish 9% 0% 0% 0% 0% 0% 91% 100%
Milk / Curd 0% 0% 3% 0% 0% 0% 97% 100%
Fruits 0% 0% 1% 0% 0% 0% 99% 100%
8.1.18.2 PRESENCE OF KITCHEN GARDENS
79% of the pregnant women from FW hamlets and 77% from NFW hamlets reported having a kitchen garden
in at least one of the seasons (winter, monsoon and summer).
8.1.18.3 WORKLOAD OF PREGNANT WOMEN, DURATION OF RESTING
These findings are based on the number of working and resting hours on the day prior to the survey, as reported
by the respondents. The working hours include household chores; work done outside and inside the house,
farming and other livelihood activities.
In FW hamlets, 18% of the women reported working more than 8 hours, which is the recommended outer
limit for pregnant women. Most women (42%) worked for 2-4 hours and another 27% reported working for
5-7 hours. In NFW hamlets a similar trend was observed with 17% women reporting working for more than 8
hours while 48 and 29% reported working for 2-4 hours and 5-7 hours respectively. Also 22% pregnant women
from FW hamlets and 19% from NFW hamlets reported that they were involved in outdoors work as well. As
many as 30% FW respondents and 27% NFW respondents reported that their work regularly involved lifting
of heavy weights. For more details refer to appendix 2.
Nearly three quarters of women both from FW and NFW hamlets got, as recommended, 8 or more hours or
rest at night. While 9 and 6% from FW and NFW hamlets respectively got less than 6 hours of rest at night.
Except for those for whom no data is available, all women reported getting at least an hour’s rest during the
day.
93
9 CONCLUSIONS
Summary of Key Findings
Demographic parameters
FW - Relationship between WAZ scores and demographic factors
NFW - Relationship between WAZ scores and demographic factors
Reference
Overall Average WAZ score is -1.86. Z score <-2sd for 45% children.
Average WAZ score is -1.82. Z score <-2sd for 43% children.
Table 6: Percentage distribution of chil-dren based on z scores
Age Over 40% malnourished in each age group.
Over 40% malnourished in each age group except for a much lower propor-tion in the 7-12 month category.
Tables 8 & 9: Per-centage distribution of children based on age groups and WAZ values-FW & NFW habitations
Gender Overall small and significant differences Overall no significant differences
Table 15: Age cate-gory-wise gender based t-test outputs for FW and NFW hab-itations
Caste
ST is the most dominant caste group (68.5%) followed by OBCs (24%)
ST is the most dominant caste group (60.4%) followed by OBCs (30%)
Table 19: :Distribu-tion of respondents based on caste cate-gory
Moderate and significant difference be-tween STs and OBCs. STs WAZ scores are weaker.
Small differences between STs and OBCs. Differences not significant.
HHI 24% reported monthly HHI of less than Rs. 1,000
12.3% reported monthly HHI of less than Rs. 1,000
Table 23: Distribution of respondents based on monthly HHI bracket
Our data shows no direct relationship with HHI
Our data shows no direct relationship with HHI
Figure 29 & 30 Distri-bution of WAZ based on household income - FW and NFW
WAZ is below -2SD for 49% of those with HHI < Rs. 1,000
WAZ is below -2SD for 39% of those with HHI < Rs. 1,000
Table 24: Percentage distribution of chil-dren based on household income and WAZ values
WAZ is below -2SD for 17% of those with HHI > Rs. 5,000
WAZ is below -2SD for 38% of those with HHI > Rs. 5,000
Livelihood Farming (83%) and daily wage work (67%) are dominant sources of livelihood
Farming (83%) and daily wage work (55%) are dominant sources of liveli-hood
Table 27: Distribution of respondents based on primary source of livelihood
Small and statistically not significant dif-ference between farming and daily wage occupations.
Small and statistically not significant difference between farming and daily wage occupations.
Moderate and statistically significant dif-ference between NREGA and Non NREGA holders.
Small differences between NREGA and Non NREGA holders.. Differences not significant.
NREGA benefit WAZ is below -2SD for 65% of non-NREGA card holders
WAZ is below -2SD for 42% of non-NREGA card holders
Table 32: Percentage distribution of chil-dren based on NREGA card status and WAZ values
94
Small, not significant differences be-tween BPL card holders and non card holders.
Moderate and statistically significant differences between BPL card holder and non card holders. Card holders are weaker.
BPL card sta-tus
Amongst those without BPL cards, WAZ score for 50% children is below -2 SD and for 21%, WAZ is less than -3 SD
Amongst those without BPL cards, WAZ score for 36% children is below -2 SD and for 11%, WAZ is less than -3 SD
Table 36: Percentage distribution of chil-dren based on BPL card status and WAZ values
Medium and statistically significant dif-ference between APL and BPL as well as APL and non-ration card holders.
Medium and not significant differences between various ration card status cat-egories.
Ration card status
57% of those without ration cards and 30% of APL card holders fall in the mod-erate malnourishment category
37% of those without ration cards and 47% of APL card holders fall in the mod-erate malnourishment category
Table 40: Percentage distribution of chil-dren based on ration card status and WAZ values
Geographical location (blocks)
Lakhanpur has the highest average WAZ and Mainpath has the lowest with the difference being medium.
Batauli has the highest average WAZ and Mainpath has the lowest with the difference being large.
Figure 35: Block wise average WAZ
Mother’s qualification
Our data shows no direct relationship with HHI
Our data shows no direct relationship with HHI
Figure 36 & 37 Distri-bution of WAZ based on mother’s educa-tion status - FW and NFW
In case of 50% respondents with no edu-cation, children's WAZ is below -2 SD
In case of 44% respondents with no ed-ucation, children's WAZ is below -2 SD
Table 48: Percentage distribution of chil-dren based on mother’s educational status and WAZ val-ues
In case of 33% respondents with more than 12 years of education,, children's WAZ is below -2 SD
In case of 40% respondents with more than 12 years of education,, children's WAZ is below -2 SD
Mother’s age of marriage
Our data shows no direct relationship with mother's marriage age
Our data shows no direct relationship with mother's marriage age
Figure 38 & 39: Distri-bution of WAZ based on mother’s marriage age - FW & NFW
Maternal work hours
Our data shows no direct relationship with maternal working hours
Our data shows no direct relationship with maternal working hours
Figure 40 & 41: Distri-bution of WAZ based on mother’s marriage age - FW & NFW
Health Ser-vices
Supplemen-tary Nutrition
71% went to the anganwadi to collect ready to eat, 88% of them received it
67% went to the anganwadi to collect ready to eat, 90.8% of them received it
Vaccination and Supple-ments
BCG, polio and DPT : over 90%; measles over 80 %.
BCG and polio : over 90%; DPT just un-der 90%, measles over 80 %.
Table 59: Status of vaccination of chil-dren in the age group 6-36 months in FW and NFW hamlets
Possibility of fever termed as the key rea-son for not availing immunization
Possibility of fever termed as the key reason for not availing immunization
NHIP 65.5% have access 58.15% have access
Health-Nutri-tional Prac-tices
95
Incidence and treatment of illnesses
Cold and cough was most prevalent. Cold and cough was most prevalent. Figure 42 & 43: Inci-dence of illnesses over last 15 days - children aged 0-6 months & 7-36 months
Treatment for 0 to 6 months, Treatment for 0 to 6 months,
diarrhea: 29% increased mother’s milk and 41 % stopped other fluids.
diarrhea: None increased mother’s milk and 33 % stopped other fluids.
Figure 44 & 45: Fluid & milk intake during diarrhea - 0-6 months
Fever: 13% increased mother’s milk 47% stopped other fluids
Fever: 33% increased mother’s milk 44% stopped other fluids
Figure 49 & 50: fluid & milk intake during fever- 0-6 months
Cold-cough: 10% increased mother’s milk and 52% stopped other fluids
Cold-cough: 15% increased mother’s milk and 45% stopped other fluids
Figure 54 & 55: Fluid & milk intake during cold and cough- 0-6 months
Treatment for 6 to 36 months, Treatment for 6 to 36 months,
diarrhea: 10 % increased fluids, 15% in-creased milk intake, 39% reduced food intake. Tendency to reduce milk and flu-ids along with food.
diarrhea: 19 % increased fluids, 7% in-creased milk intake, 48% reduced food intake. Tendency to reduce milk and fluids along with food.
Figure 46, 47 & 48: Fluid, milk & food in-take during diarrhea - 6 months to 3 years
Fever: 24% gave normal fluids, 30% gave normal levels of milk, 11% gave normal levels of food. Tendency to reduce in-take.
Fever: 33% gave normal fluids, 43% gave normal levels of milk, 28% gave normal levels of food. Tendency to re-duce intake.
Figure 51, 52 & 53: Fluid, milk & food in-take during fever- 6 months to 3 years
Cold and Cough: 33% gave normal levels of fluids, 35% gave normal levels of milk, 25% gave normal levels of food. Ten-dency to reduce intake.
Cold and Cough: 39% gave normal lev-els of fluids, 52% gave normal levels of milk, 38% gave normal levels of food. Tendency to reduce intake.
Figure 56, 57 & 58: Fluid, milk & food in-take during cold and cough - 6 months to 3 years
Weight moni-toring
Of the 56% mothers who reported on monitoring their child’s weight, 76% were informed that their children’s weight was normal.
Of the 38% mothers who reported on monitoring their child’s weight,83% were informed that their children’s weight was normal.
Table 63 : Status of children’s weight monitoring
Breast feeding and weaning practices
99% mothers reported breast feeding their child, and 61% breastfed within the first hour.
98% mothers reported breast feeding their child, and 71% breastfed within the first hour.
Figure 59: Time of first breast feeding of a newborn & figure 62: infants aged 0-6 months being breast-fed by mother
86% are given colostrum. 85% are given colostrum. Figure 60: Status of colostrum being given to newborns
Complementary nutrition started at the age of 6 months or later by 65% mothers.
Complementary nutrition started at the age of 6 months or later by 68% mothers.
Figure 61: Time of starting complemen-tary nutrition
Food composi-tion and fre-quency of in-take
32% children between 6 months to 3 years had 3 meals and 27% had four meals a day. 13% less than the recom-mended 3 meals. 53% don’t add oil.
27% children between 6 months to 3 years had 3 meals and 23% had four meals a day. 19% less than the recom-mended 3 meals. 70% don’t add oil.
Figure 64: Frequency of eating - children aged 6 months - 3 years & figure 65: fre-quency of adding oil to food - children aged 6 months - 3 years
Rice is taken more than twice a day by 78% children.
Rice is taken more than twice a day by 66% children.
96
24% don't get any pulses. Nearly 40% children did not get any green vegetables and potato, and more than 70 % children don’t get eggs and other vegetables, and more than 90% children did not consume meat, fish, milk/curd and fruits.
30% to 60% children did not get any pulses, green vegetables, and potato, and more than 70 % children don’t get other vegetables, and more than 90% children did not consume egg, meat, fish, milk/ curd and fruits.
Table 64: Food com-position - children 6 months - 3 years
Kitchen gar-dens
97% reported having a kitchen garden in at least one season.
97% reported having a kitchen garden in at least one season.
Table 65: Prevalence of kitchen gardens
Psychosocial Care and stim-ulation
Bathing prac-tices
Mothers are available during bathing, and talk to the child. Talking happens more at a functional level. More stimu-lating activities like play, complex talk are much less visible.
Mothers are available during bathing, and talk to the child. Talking happens more at a functional level. More stimu-lating activities like play, complex talk are much less visible.
Table 69: Psychoso-cial stimulation dur-ing bathing time
Only one activity of ‘talking to the child’ was practiced by a large majority of peo-ple in three different age groups.
Only one activity of ‘talking to the child’ was practiced by a large majority of people in three different age groups.
Other activities of stimulation while pre-sent, were followed only by a moderate number.
Other activities of stimulation while present, were followed only by a mod-erate number.
Mealtime practices
Talking to the child is more prevalent in the younger age group.
Talking to the child is more prevalent in the younger age group.
Table 70: Psychoso-cial stimulation dur-ing meal time
In the later two age groups, eating to-gether takes place, but conversation seems to reduce.
In the later two age groups, eating to-gether takes place, but conversation seems to reduce.
Most activities enhancing psychosocial stimulation were followed by a moderate number of respondents.
Most activities enhancing psychosocial stimulation were followed by a moder-ate number of respondents.
Sleeping prac-tices
For the first two age groups, singing, play and talk are adopted by moderate num-ber of participants.
For the first two age groups, singing, play and talk are adopted by moderate number of participants.
Table 71: Psychoso-cial stimulation dur-ing sleep time
Play is an important stimulation activity reported by a high number of respond-ents of the later two age groups.
Play is an important stimulation activity reported by a high number of respond-ents of the later two age groups.
Other stimulation activities fall in a low or moderately adopted category.
Other stimulation activities fall in a low or moderately adopted category.
Free time practices
For the first two age groups, several kinds of activities were reported by moderate or low number of respondents.
For the first two age groups, several kinds of activities were reported by moderate or low number of respond-ents.
Table 72: Psychoso-cial stimulation dur-ing free time
In the second age group, a high percent-age of mothers reported playing.
In the second age group, a high per-centage of mothers reported playing.
Playing and taking the child outdoors, talking to neighbors was also an activity reported by high percentage in the older two age groups. Playing was reported by a moderate percentage of mothers.
Playing and taking the child outdoors, talking to neighbors was also an activity reported by high percentage in the older two age groups. Playing was re-ported by a moderate percentage of mothers.
97
Use of toys A wide range of makeshift toys and games is visible, however only by a mod-erate percentage of mothers across all age groups.
A wide range of makeshift toys and games is visible, however only by a moderate percentage of mothers across all age groups.
Table 73: Psychoso-cial stimulation dur-ing toy time
Health-Nutri-tion Services for Pregnant & Lactating Women
Access and usage
Pregnancy registration
81% registered their pregnancy. 87% registered their pregnancy.
ANC care Amongst pregnant women, tetanus in-jection and iron tablets were most com-monly availed by more than 70% women. Most other services were availed by about 50% or less.
Amongst pregnant women, tetanus in-jection and iron tablets were most commonly availed by more than 70% women. Most other services were availed by about 50% or less.
Table 74: Status of usage of ANC ser-vices by lactating mothers and preg-nant women
Amongst lactating women, more than 70% women availed of iron tables. Most other services were availed by much fewer women, mostly below 50%.
Amongst lactating women, more than 70% women availed of iron tables amd tetanus injections. Most other services were availed by much fewer women, mostly below 50%. Abdominal exami-nation was the least availed service.
Institutional Delivery
57% women had institutional deliveries, and 42% reported having unassisted de-liveries at home. Those with medically assisted home-based deliveries were marginal.
63% women had institutional deliver-ies, and 32% reported having unas-sisted deliveries at home. Those with medically assisted home-based deliver-ies were marginal.
Table 75: Type of de-livery - lactating women / mother of 0-6 months olds
56% pregnant women were planning in-stitutional deliveries
38.6% pregnant women were planning institutional deliveries
PPC Only 23% women had availed of PPC ser-vices while 45% reported facing health problems post delivery
Only 25% women had availed of PPC services
Appendix 2: Health and nutrition services and practices for pregnant and lactat-ing women
Supplemen-tary nutrition
Only 50% of the total respondents re-ceived ready-to-eat take-home-ration.
Only 57% of the total respondents re-ceived ready-to-eat take-home-ration.
NHIP 61.36% of the women were covered un-der the NHIP
60.76% of the women were covered under the NHIP
Health-Nutri-tion Practices for Pregnant and Lactating Women
Status of adoption/implementation of practices
Nutrition Rice-intake was most common both, amongst pregnant and lactating women
Rice-intake was most common both, amongst pregnant and lactating women
Table 79 & 80: Food composition - preg-nant women & lac-tating mothers
Dals, green vegetables and potatoes were not consumed at all by 30 to 50% pregnant women and about 40 to 60% lactating women.
Dals, green vegetables and potatoes were not consumed at all by 30 to 50% pregnant women and about 60 to 70% lactating women.
More than 90% women, pregnant or lac-tating, do not consume meat, fish, milk and fruits.
More than 90% pregnant women do not consume meat, fish, milk and fruits. None of the lactating women consume meat fish, milk / curd and fruits
Kitchen gar-dens
79% women have a kitchen garden in at least one of the seasons.
77% women have a kitchen garden in at least one of the seasons.
98
Workload and rest
18% of the women reported working more than 8 hours a day.
17% of the women reported working more than 8 hours a day.
Appendix 2: Health and nutrition ser-vices and practices for pregnant and lac-tating women
30% reported their work involved lifting heavy weights on a regular basis
30% reported their work involved lift-ing heavy weights on a regular basis
74% got 8 or more hours of rest at night and 9% got less than 6 hours
79% got 8 or more hours of rest at night and 6% got less than 6 hours
All women got at least an hour's rest dur-ing the day
All women got at least an hour's rest during the day
99
This study concludes that the malnutrition in Surguja is significant and pervasive. When analyzed based on
various demographic indicators, the differences were not statistically significant. Even where they are statisti-
cally significant, as in the case of gender, caste and ration card status, the differences are not large enough to
warrant any differentiated intervention. One exception to this may be the Mainpath block, which is the only
block where the average WAZ falls into the moderate malnutrition category.
Analysis of the data also reveals substantial differences between FW and NFW hamlets as far as both respond-
ent profiles and nutritional status is concerned. A NFW respondent was more likely to have a higher income,
have received more education, have a government job or private business, have a separate place for cooking
and have access to a hand-pump, toilet and electricity. He was, at the same time, more likely to have access to
a BPL card and a BPL ration card.
TABLE 81: COMPARATIVE PROFILE OF RESPONDENTS ON SELECT DEMOGRAPHIC INDICATORS
An NFW respondent was more likely to be better off
Indicator FW NFW
Illiterate 53.77% 47.06%
8 or more years of education 23.62% 29.95
Have a private or govt. job 2.05% 7.50%
Monthly HHI < Rs. 1,000 23.97% 12.30%
Have BPL cards 63.36% 68.45%
Have BPL ration cards 56.51% 62.03%
Have a separate cooking space 45.89% 63.63%
Have access to a hand pump 55.47% 68.44%
Have access to a toilet 12.00% 19.24%
Have access to electricity 63.69% 81.28%
These differences play out in interesting ways between FW and NFW hamlets as far as nutritional status is
concerned. At an aggregated level, the two categories do not seem to differ significantly in nutritional status.
However, in NFW hamlets, there is little difference between the nutritional status of ST’s and OBC’s, between
NREGA beneficiaries and non-beneficiaries or between APL and BPL ration card holders. In the case of FW
hamlets, this difference in each case is much sharper.
Overall, this suggests not only that the strategy of letting communities take the initiative in setting up of fulwaris
is drawing the more vulnerable of them into the programme in its early days, but also that such communities
are characterized by the at-risk sub-communities being more at risk. It appears likely, therefore, that the fulwari
programme , in the way it selects locations, is responding to a real need in the communities for the initiative.
TABLE 82: VARIATION IN DISTRIBUTION OF WAZ ACROSS SELECT DEMOGRAPHIC INDICATORS BETWEEN FW AND NFW
HAMLETS
The Worse-off are Much Worse Off in FW Locations
Criteria Fulwari (WAZ<-2SD) Non-Fulwari (WAZ<-2SD)
Caste - ST vs OBC 51% 41% 42% 39%
Income <1000 vs >5000 49% 17% 39% 38%
NREGA Support -No vs Yes 65% 45% 42% 45%
Ration Card None vs APL 57% 30% 37% 47%
100
Some of the findings appear counter-intuitive, as well as contrary to the findings from some other nation-wide
studies. For instance, there appears to be little relationship of nutritional status with income. Another area
where we fail to find a correlation with nutritional status is for the level of mother’s education. A national level
study found a significant difference in the nutritional status of children where the mothers had had more than
10 years of education.
Part of the explanation for this, at least for income, may be that in a tribal rural setting with a large prevalence
of a non-cash economy, there is a difficulty in establishing a meaningful indicator of income. It is also true that
we see substantial reluctance on part of respondents to answer income-related questions.
However, the larger explanation seems to lie in the S-curve effect. We notice, for instance, that the nutrition
indicators do improve significantly once the income increases beyond about Rs. 5,000. Similarly, mother’s ed-
ucation seems to have a definite effect beyond about 10 years of education.
This suggests that a minimum level of a beneficial characteristic needs to be reached before it begins to have
an impact on the nutritional status. This has important implications for various initiatives aiming at malnutrition
eradication and suggests that intensity of programme intervention may be an important factor in whether the
programme is successful.
There seems to be a reasonably widespread adoption rate of vaccination and supplementary nutrition services,
with the exception of NHIP which leaves out forty percent of the people. The incidence of cold and cough is
very high and diarrhea and fever are also quite frequent, likely the direct result of poor nutritional levels. More-
over, there is a weak adoption of recommended practices for treatment of these illnesses and suggests a need
for strengthening awareness about these practices. Only two-thirds of the mothers reported monitoring their
child’s weight, a concern in a place where malnutrition is a widespread issue. Of even greater concern is the
fact that seventy percent of the mothers report being informed that their child’s weight is normal. Given that
more than forty percent of the children under three are, in fact, malnourished, this misinformation can lead to
complacency and lack of adoption of appropriate measures by the parents. This aspect clearly needs attention.
While breastfeeding and colostrum administration is widespread, awareness about the importance of first hour
feeding, and complementary nutrition at six months is well below universal. The community awareness pro-
grams need to therefore enhance their focus on these areas. The absence of pulses, greens and oils in the food
composition is a matter of concern as this leads to low levels of macro and micro nutrients in the diet
TABLE 83: VARIATION IN ADOPTION OF SUGGESTED HEALTH AND NUTRITION PRACTICES BETWEEN FW AND NFW HAMLETS
Fulwaris Seem to Help
Behaviour FW NFW
Children weighed in previous month 73% 50%
Of, these, children reported normal 76% 83%
Pregnant mothers taking iron tablets in the previous week 83% 61%
Adding oil to children’s food twice or more 31% 12%
Children eating three times a day 32% 27%
Children eating four times a day 27% 23%
Children eating dal at least once a day 76% 60%
Children eating egg at least once a day 23% 4%
101
While these behavior changes are encouraging, respondents in both FW and NFW reported a sharply lower
incidence of these behaviors in just the previous week. We would therefore, consider these results more a
reflection of an increased awareness of desirable behavior rather than an actual change of behavior at this early
stage.
As far as psychosocially stimulating practices are concerned, it appears that a substantial number of parents do
not spend much time engaged in such activities with their children. Amongst those who do spend the time, the
engagement is more functional than one that might enhance the child’s psychosocial capacities. Such stimulating
activities as play, complex talk, versatile toys, providing opportunities for self-reliant activities like bathing, and
eating are not very widespread. Awareness of the value of and skills for such activities need to be enhanced
through good parenting programs.
While pregnancy is registered by a fairly large number of women, adoption of ANC services other than iron
tablets and tetanus injections is limited. Awareness and promotion of these services amongst pregnant women
needs to be strengthened through appropriate community programs.
Nutritional practices of pregnant and lactating women, like that of children, are likely to lead to low levels of
macro and micro nutrient ingestion. A greater awareness that pregnant and lactating women need a different
diet is obviously required, but availability may be a major factor.
102
10 APPENDICES
Appendix 1: Profile of respondents: pregnant women
Caste category profile
Caste Category FW NFW ALL
General 1% 1% 1%
SC 7% 8% 7%
ST 65% 58% 63%
OBC 22% 27% 24%
Others 2% 0% 1%
No Response 3% 6% 4%
Total no. of respondents 132 79 211
Age profile
Age bracket FW NFW ALL
<18 1% 3% 2%
18-20 Yrs 22% 24% 23%
21-25 Yrs 46% 42% 43%
26-30 Yrs 28% 21% 24%
>30 Yrs 1% 7% 5%
No Response 3% 3% 3%
Total no. of respondents 132 79 211
Distribution by age at the time of marriage
Age bracket FW NFW ALL
<18 37% 34% 36%
18-20 Yrs 54% 51% 53%
21-25 Yrs 8% 13% 10%
26-30 Yrs 0% 3% 1%
>30 Yrs 1% 0% 0%
Total no. of respondents 132 79 211
103
Distribution by number of pregnancies
Number of Pregnancies FW NFW ALL
1 35% 35% 35%
2 24% 38% 29%
3 20% 14% 18%
4 8% 8% 8%
5 7% 3% 5%
6 1% 0% 0%
7 2% 0% 1%
No Response 4% 3% 3%
Total no. of respondents 132 79 211
Distribution by number of children
Number of Children FW NFW ALL
0 40% 37% 39%
1 28% 37% 31%
2 19% 22% 20%
3 5% 3% 4%
4 5% 3% 4%
5 2% 0% 1%
Total no. of respondents 132 79 211
Literacy status profile
No. of years of education FW NFW ALL
Illiterate 48% 49% 49%
1-4 6% 3% 5%
5-7 13% 23% 17%
8-9 23% 15% 20%
10-11 8% 8% 8%
12 and Above 1% 3% 1%
Total no. of respondents 132 79 211
104
Monthly household income profile
Monthly household income bracket FW NFW ALL
<1001 42% 23% 35%
1001-2000 37% 46% 40%
2001-3000 13% 15% 14%
3001-4000 2% 5% 3%
4001-5000 0% 1% 0%
>5001 0% 3% 1%
No Response 6% 8% 7%
Total no. of respondents 132 79 211
Distribution by primary source of livelihood
Source of livelihood FW NFW ALL
Farming 79% 85% 81%
Daily wage work 71% 61% 67%
Govt. job 1% 6% 3%
Self employed 6% 4% 5%
Pvt. Job 0% 3% 1%
Others 2% 1% 1%
No Response 0% 3% 0%
Total no. of respondents 132 79 211 *Multiple responses were possible thus percentage totals may be more than 100.
NREGA Benefits
NREGA card status FW NFW ALL
Yes 83% 68% 78%
No 17% 29% 21%
No Response 0% 3% 1%
Total no. of respondents 132 79 211
Worked at NREGA FW NFW ALL
Yes 77% 63% 72%
No 14% 13% 13%
No Response 10% 24% 1%
Total no. of respondents 132 79 211
105
BPL Card Status
BPL card status FW NFW ALL
Yes 71% 63% 68%
No 26% 35% 29%
No Response 3% 1% 2%
Total no. of respondents 132 79 211
Ration card status
Ration Card Status FW NFW ALL
APL 8% 11% 9%
BPL 69% 62% 66%
NRC 16% 15% 16%
No Response 8% 11% 9%
Total no. of respondents 132 79 211
Household assets owned by respondents
Household assets FW NFW ALL
2 acre land 31% 41% 35%
House with >= 3 rooms 43% 33% 39%
Rented out house with >Rs. 500 rent pm 2% 0% 1%
TV 20% 16% 18%
Radio 9% 8% 9%
Mobile phone 62% 62% 62%
Two wheeler 9% 13% 10%
Four wheeler 1% 1% 1%
Cycle 61% 71% 64%
Bullock cart 1% 1% 1%
Pressure cooker 14% 16% 15%
Cot 63% 63% 63%
Fan 22% 24% 23%
Cooler 3% 5% 4%
Clock 60% 70% 64%
No Response 10% 1% 7%
Total no. of respondents 132 79 211
106
Distribution by type of house respondents live in
Type of House FW NFW ALL
Pakka 2% 1% 1%
Part pakka 2% 3% 2%
Kutcha 95% 96% 95%
Others 1% 0% 0%
No Response 1% 0% 0%
Total no. of respondents 132 79 211
Distribution by ownership of house
Ownership of House FW NFW ALL
Self owned 97% 97% 97%
Rented 1% 0% 0%
Others 2% 1% 1%
No Response 1% 1% 1%
Total no. of respondents 132 79 211
Toilet facility used
Type of toilet facility used FW NFW ALL
Toilet at home 15% 22% 18%
Public toilet 2% 3% 2%
Open space 83% 76% 80%
Others 0% 0% 0%
Total no. of respondents 132 79 211
Status of access to electricity
Have access to electricity FW NFW ALL
Yes 64% 84% 71%
No 36% 15% 28%
No Response 1% 1% 1%
Total no. of respondents 132 79 211
107
Main source of light
Main Source of Light FW NFW ALL
Electricity 59% 81% 67%
Kerosene oil 64% 59% 63%
Solar power 4% 0% 2%
Other oils 5% 3% 4%
Nothing 0% 0% 0%
Others 0% 0% 0%
No Response 1% 0% 0%
Total no. of respondents 132 79 211
Source of drinking water
Source of Drinking Water FW NFW ALL
House tap 1% 6% 3%
Public tap 13% 19% 15%
Hand pump 60% 61% 60%
Others 29% 32% 30%
No Response 2% 0% 1%
Total no. of respondents 132 79 211
Cooking fuel used
Cooking fuel used FW NFW ALL
Wood 99% 97% 99%
Coal 1% 0% 0%
Kerosene oil 1% 0% 0%
LPG 2% 0% 1%
Biogas 0% 0% 0%
Others 1% 6% 3%
Total no. of respondents 132 79 211
Place of cooking
Place of cooking FW NFW ALL
Room where the family sleeps 42% 29% 37%
Another room 58% 71% 63%
Outdoors 0% 0% 0%
Total no. of respondents 132 79 211
108
Kind of chulha used
Have a smokeless chulha FW NFW ALL
Yes 17% 11% 15%
No 81% 87% 83%
No Response 2% 1% 2%
Total no. of respondents 132 79 211
109
Appendix 2: Health and nutrition services and practices for pregnant and lactating
women
Number of ANC checkups undergone
No. of ANC checkups - Pregnant women
FW FW (%) NFW NFW ( %) All All ( %)
0 54 43.20% 29 38.67% 83 41.50%
1 32 25.60% 23 30.67% 55 27.50%
2 23 18.40% 11 14.67% 34 17.00%
3 11 8.80% 7 9.33% 18 9.00%
4 3 2.40% 1 1.33% 4 2.00%
Above 4 2 1.52% 4 5.06% 6 2.84%
No Resp. 7 5.30% 4 5.06% 11 5.21%
Total 132 79 211
No. of ANC checkups - Lactat-ing women FW FW (%) NFW NFW ( %) All All ( %)
0 0 0% 0 0% 0 0%
1 15 22% 11 27% 26 24%
2 16 23% 6 15% 22 20%
3 12 17% 11 27% 23 21%
4 7 10% 2 5% 9 8%
Above 4 2 3% 3 7% 5 5%
No Resp. 17 25% 8 20% 25 23%
Total 69 41 110
ANC check-up of pregnant women conducted by
ANC check up conducted by
FW FW (%) NFW NFW ( %) All All ( %)
Private Doctor 19 14% 9 11% 28 13%
Govt. Doctor 29 22% 24 30% 53 25%
Nurse / ANM 30 23% 10 13% 40 19%
Others 4 3% 6 8% 10 5%
No Resp. 54 41% 31 39% 85 40%
Grand Total 132 79 211
110
Motivators for ANC checkups (pregnant women)
Motivator for ANC FW FW (%) NFW NFW ( %) All All ( %)
ANM 6 5% 6 8% 12 6%
AWW 17 13% 16 20% 33 16%
Mitanin 30 23% 38 48% 68 32%
Husband 26 20% 10 13% 36 17%
Mother-in-law 24 18% 8 10% 32 15%
Mother 3 2% 4 5% 7 3%
Relatives/friends 5 4% 4 5% 9 4%
Self 10 8% 6 8% 16 8%
Others 4 3% 4 5% 8 4%
No Resp. 47 36% 22 28% 69 33%
Total 132 79 211
Iron tablet intake
Number of iron tablets FW FW (%) NFW NFW ( %) All All ( %)
0 0 0% 0 0% 0 0%
1-20 32 24% 17 22% 49 23%
21-40 18 14% 11 14% 29 14%
41-60 19 14% 13 16% 32 15%
61-80 1 1% 2 3% 3 1%
81-100 10 8% 6 8% 16 8%
More than 100 4 3% 1 1% 5 2%
No Response 48 36% 29 37% 77 36%
Total 132 79 211
Iron syrup intake
Number of syrup bottles FW FW (%) NFW NFW ( %) All All ( %)
1 16 12% 5 6% 21 10%
2 4 3% 5 6% 9 4%
3 1 1% 1 1% 2 1%
>3 1 1% 1 1% 2 1%
No Response 110 83% 67 85% 177 84%
Total 132 62.56% 79 37.44% 211
111
Illnesses or symptoms of complications reported by lactating mothers during their last pregnancy
Symptoms of complications reported FW FW (%) NFW NFW ( %) All All ( %)
Severe Headache 32 46% 9 22% 41 37%
Dizziness 41 59% 13 32% 54 49%
Blurred vision 29 42% 6 15% 35 32%
Feeling shaky (jhatke aanaa) 8 12% 2 5% 10 9%
Bleeding 6 9% 2 5% 8 7%
Chronic stomach ache 28 41% 12 29% 40 36%
Fever and chills 26 38% 13 32% 39 35%
Severe Weakness 34 49% 11 27% 45 41%
Hypertension 2 3% 2 5% 4 4%
Anemia 16 23% 6 15% 22 20%
Others 1 1% 3 7% 4 4%
No illness 9 13% 10 24% 19 17%
No response 4 6% 6 15% 10 9%
Total 69 41 110
PPC checkups undergone or not within a month of last delivery (Lactating women)
Did you undergo a PPC check up within a month of delivering? FW FW (%) NFW NFW ( %) All All ( %)
Yes 16 23% 8 20% 24 22%
No 52 75% 31 76% 83 75%
No Resp 1 1% 2 5% 3 3%
Total 69 41 110
Number of PPC checkups undergone within a month of last delivery (Lactating women)
Number of PPC check-ups undergone within a month of delivery FW FW (%) NFW NFW ( %) All All ( %)
0 0 0% 0 0% 0 0%
1 6 9% 6 15% 12 11%
2 6 9% 2 5% 8 7%
3 2 3% 0% 2 2%
>3 1 1% 2 5% 3 3%
No Response 54 78% 31 76% 85 77%
Total 69 41 110
112
PPC check up after last delivery conducted by (Lactating women)
PPC check up con-ducted by FW FW (%) NFW NFW ( %) All All ( %)
Doctor 15 22% 8 20% 23 21%
ANM 1 1% 1 2% 2 2%
Dai 0 0% 0 0% 0 0%
Others 1 1% 3 7% 4 4%
No response 52 75% 29 71% 81 74%
Total 69 41 110
PPC check-up after last delivery conducted at (Lactating women)
PPC checkup after last delivery conducted at FW FW (%) NFW NFW ( %) All All ( %)
Govt. Hospital 12 17% 6 15% 18 16%
Pvt. Hospital 4 6% 3 7% 7 6%
Anganwadi 0 0% 0 0% 0 0%
Home 2 3% 1 2% 3 3%
Others 1 1% 1 2% 2 2%
No response 50 72% 30 73% 80 73%
Total 69 41 110
Were any problems faced after the last delivery (Lactating women?)
Did you face any prob-lems after delivery? FW FW (%) NFW NFW ( %) All All ( %)
Yes 31 45% 8 20% 39 35%
No 38 55% 33 80% 71 65%
No Response 0 0% 0 0% 0 0%
Total 69 41 110
113
Number of hours pregnant women work
No. of hours worked the previous day FW FW (%) NFW NFW ( %) All All ( %)
<2 hrs 10 8% 3 4% 13 6%
2-4 hrs 56 42% 38 48% 94 45%
5-7 hrs 35 27% 23 29% 58 27%
8-10 hrs 17 13% 11 14% 28 13%
11-13 hrs 5 4% 2 3% 7 3%
>13 hrs 1 1% 0 0% 1 0%
No Response 8 6% 2 3% 10 5%
Total 132 79 211
Type of work pregnant women do
Work involving lifting heavy weights FW FW (%) NFW NFW ( %) All All ( %)
Not at all 31 23% 13 16% 44 21%
Some days 59 45% 43 54% 102 48%
Almost all days 39 30% 21 27% 60 28%
No Response 2 2% 3 4% 5 2%
Total 132 79 211
Outdoors work FW FW (%) NFW NFW ( %) All All ( %)
Yes 29 22% 15 19% 44 21%
No 101 77% 62 78% 163 77%
No Response 2 2% 2 3% 4 2%
Total 132 79 211
Number of hours pregnant women rest during the day
No. of hours rested during the day on the previous
day FW FW (%) NFW NFW ( %) All All ( %)
<1hr 0 0% 0 0% 0 0%
1-2Hr 79 60% 39 49% 118 56%
3-4Hr 23 17% 27 34% 50 24%
>4Hr 19 14% 10 13% 29 14%
No Response 11 8% 3 4% 14 7%
Total 132 79 211
114
Number of hours pregnant women rest at night
No. of hours rested at night on the previous day FW FW (%) NFW NFW ( %) All All ( %)
<6hr 12 9% 5 6% 17 8%
7hr 18 14% 9 11% 27 13%
8hr 53 40% 35 44% 88 42%
>8hr 45 34% 28 35% 73 35%
No Response 4 3% 2 3% 6 3%
Total 132 79 211
Availability and usage of mosquito nets (pregnant women)
Mosquito net availability FW FW (%) NFW NFW ( %) All All ( %)
YES 89 67.42% 47 59.49% 136 64.45%
NO 37 28.03% 27 34.18% 64 30.33%
No Resp 6 4.55% 5 6.33% 11 5.21%
Total 132 79 211
Mosquito net usage FW FW (%) NFW NFW ( %) All All ( %)
Yes 72 80.90% 32 68.09% 104 76.47%
No 17 19.10% 15 31.91% 32 23.53%
Total 89 47 136
115
Appendix 3: Hygiene related practices - pregnant women
Hand washing practices
What do you mostly wash hands with? Percentage of respondents
FW NFW Overall
Soap 84% 92% 87%
Ash 23% 30% 26%
Others 2% 4% 3%
No Resp. 5% 1% 3%
Total no. of respondents 132 79 211
When do you wash hands using soap? Percentage of respondents
FW NFW Overall
After using the toilet 86% 92% 89%
Before eating 55% 38% 49%
Before cooking 42% 37% 40%
Before feeding the child 35% 27% 32%
After helping the child with defecation 54% 61% 56%
After handling mud or cow dung 73% 81% 76%
Others 11% 5% 9%
No response 5% 1% 3%
Total no. of respondents 132 79 211
Practices for cleaning drinking water
Practices for cleaning water Percentage of respondents
FW NFW Overall
Boiling 23% 18% 31%
Bleach / Chlorine 3% 2% 4%
Sieve using a cloth 34% 32% 49%
Alum 0% 0% 0%
Others 3% 1% 3%
Nothing 16% 24% 28%
No response 20% 24% 32%
Total no. of respondents 132 79 211
116
Practices for taking water from the vessel
Practices for taking water Percentage of respondents
FW NFW Overall
Vessel with handle 27% 29% 27%
Glass/mug/jug 71% 72% 72%
Others 4% 1% 3%
No Response 2% 1% 1%
Total no. of respondents 132 79 211
117
Appendix 4: Hygiene related practices – mothers of children aged 0-3 years
Hand washing practices
What do you mostly wash hands with? Percentage of respondents
FW NFW Overall
Soap 83% 87% 84%
Ash 30% 29% 30%
Others 1% 2% 1%
No response 1% 3% 2%
Total no. of respondents 292 187 479 Multiple replies were possible thus the total of percentages might be more than 100.
When do you wash hands using soap? Percentage of respondents
FW NFW Overall
After using the toilet 89% 91% 90%
Before eating 50% 42% 47%
Before cooking 44% 41% 43%
Before feeding the child 41% 36% 39%
After helping the child with defecation 64% 76% 69%
After handling mud or cow dung 77% 82% 79%
Others 9% 6% 8%
No response 4% 1% 3%
Total no. of respondents 292 187 479
Practices for cleaning drinking water
Practices for cleaning water Percentage of respondents
FW NFW Overall
Boiling 25% 24% 25%
Bleach / Chlorine 4% 2% 4%
Sieve using a cloth 56% 43% 51%
Alum 1% 1% 1%
Others 2% 0% 1%
Nothing 29% 42% 34%
No response 4% 3% 4%
Total no. of respondents 292 187 479
118
Practices for taking water from the vessel
Practices for taking water Percentage of respondents
FW NFW Overall
Vessel with handle 28% 34% 30%
Glass/mug/jug 74% 71% 73%
Others 2% 1% 2%
No response 1% 1% 1%
Total no. of respondents 292 187 479
119
Appendix 5: Practices for treatment of diarrhea for 0-6 month olds
Was the child given any rehydrating fluid or not
Rehydrating fluid given or not Percentage of Respondents
FW NFW Overall
Yes 41% 11% 31%
No 59% 89% 69%
No Resp. 0% 0% 0%
Total No. of respondents 17 9 26
Kind of rehydrating fluid given to the child
Kind of rehydrating fluid Percentage of Respondents
FW NFW
Overall
ORS 35% 11% 27%
Salt/Sugar 6% 0% 4%
Rice soup with salt – ‘pasiya’ 0% 0% 0%
More water 0% 0% 0%
Natural Tea/Kadha 6% 0% 4%
Others 6% 11% 8%
No Resp. 47% 78% 58%
Total No. of respondents 17 9 26
Who was consulted by parents for advice or treatment?
Consulted for treatment / advice Percentage of Respondents
FW NFW Overall
Mitanin 29% 22% 27%
AWC 6% 0% 4%
ANM 0% 0% 0%
Male Health Worker 0% 0% 0%
Govt. Hospital 18% 11% 15%
Pvt. Doctor/Hospital 18% 22% 19%
Tantric 0% 0% 0%
Nobody 24% 22% 23%
Others 0% 11% 4%
No Response 6% 11% 8%
Total No. of respondents 17 9 26
120
Expenditure incurred for treating diarrhea:
Expenditure on treating diarrhea Percentage of Respondents
FW NFW Overall
< Rs.100 6% 0% 4%
Rs.100 - Rs. 500 29% 22% 27%
Rs. 501 - Rs. 1000 0% 0% 0%
Rs. 1001 - Rs. 2000 0% 0% 0%
> Rs. 2000 0% 0% 0%
No Response 65% 78% 69%
Total No. of respondents 17 9 26
121
Appendix 6: Practices for treatment of fever for 0-6 month olds
Who was consulted by parents for advice or treatment?
Consulted for treatment / advice Percentage of Respondents
FW NFW Overall
Mitanin 33% 0% 21%
AWC 0% 0% 0%
ANM 7% 0% 4%
Male Health Worker 0% 0% 0%
Govt. Hospital 40% 22% 33%
Pvt. Doctor/Hospital 13% 44% 25%
Tantric 7% 0% 4%
Nobody 13% 11% 13%
Others 7% 11% 8%
No Response 0% 11% 4%
Total No. of respondents 15 9 24
Expenditure incurred for treating fever
Expenditure on treating fever Percentage of Respondents
FW NFW Overall
< Rs.100 7% 0% 4%
Rs.100 - Rs. 500 33% 56% 42%
Rs. 501 - Rs. 1000 13% 0% 8%
Rs. 1001 - Rs. 2000 7% 0% 4%
> Rs. 2000 0% 0% 0%
No Response 40% 44% 42%
Total No. of respondents 15 9 24
122
Appendix 7: Practices for treatment of cold and cough for 0-6 month olds
Who was consulted by parents for advice or treatment?
Consulted for treatment / advice Percentage of Respondents
FW NFW Overall
Mitanin 33% 5% 24%
AWC 0% 0% 0%
ANM 2% 0% 2%
Male Health Worker 0% 0% 0%
Govt. Hospital 10% 20% 13%
Pvt. doctor/Hospital 17% 35% 23%
Tantric 10% 5% 8%
Nobody 31% 25% 29%
Others 2% 5% 3%
No Response 0% 0% 0%
Total no. of respondents 42 20 62
Expenditure incurred for treating cold and cough
Expenditure on treating cold and cough Percentage of Respondents
FW NFW Overall
< Rs.100 12% 20% 15%
Rs.100 - Rs. 500 19% 40% 26%
Rs. 501 - Rs. 1000 2% 0% 2%
Rs. 1001 - Rs. 2000 0% 5% 2%
> Rs. 2000 0% 0% 0%
No Response 67% 35% 56%
Total no. of respondents 42 20 62
123
Appendix 8: Practices for treatment of diarrhea for 6 - 36 month olds
Was the child given any rehydrating fluid or not
Rehydrating fluid given or not Percentage of Respondents
FW NFW Overall
Yes 66% 57% 62%
No 31% 31% 31%
No Response 3% 12% 7%
Total No. of respondents 61 42 103
Kind of rehydrating fluid given to the child
Kind of rehydrating fluid Percentage of Respondents
FW NFW Overall
ORS 54% 43% 50%
Salt/Sugar 5% 24% 13%
Rice soup with salt 7% 10% 8%
More water 5% 2% 4%
Natural Tea/Kadha 2% 0% 1%
Others 3% 5% 4%
No Response 36% 38% 37%
Total No. of respondents 61 42 103
Who was consulted by parents for advice or treatment?
Consulted for treatment / advice Percentage of Respondents
FW NFW Overall
Mitanin 33% 19% 27%
AWC 3% 2% 3%
ANM 5% 5% 5%
Male Health Worker 0% 2% 1%
Govt. Hospital 13% 19% 16%
Pvt. doctor/Hospital 23% 26% 24%
Tantric 7% 2% 5%
Nobody 5% 7% 6%
Others 3% 2% 3%
No Response 25% 33% 28%
Total No. of respondents 61 42 103
124
Expenditure incurred for treating diarrhea
Expenditure on treating diarrhea Percentage of Respondents
FW NFW Overall
< Rs.100 11% 5% 9%
Rs.100 - Rs. 500 18% 33% 24%
Rs. 501 - Rs. 1000 10% 5% 8%
Rs. 1001 - Rs. 2000 2% 2% 2%
> Rs. 2000 0% 0% 0%
No Response 59% 55% 57%
Total No. of respondents 61 42 103
125
Appendix 9: Practices for treatment of fever for 6 - 36 month olds
Who was consulted by parents for advice or treatment?
Consulted for treatment / advice Percentage of Respondents
FW NFW Overall
Mitanin 25% 22% 24%
AWC 3% 2% 2%
ANM 1% 3% 2%
Male Health Worker 0% 0% 0%
Govt. Hospital 25% 26% 26%
Pvt. doctor/Hospital 34% 31% 33%
Tantric 8% 2% 5%
Nobody 11% 10% 11%
Others 1% 3% 2%
No Response 7% 9% 8%
Total no. of respondents 71 58 129
Expenditure incurred for treating fever
Expenditure on treating fever Percentage of Respondents
FW NFW Overall
< Rs.100 6% 7% 6%
Rs.100 - Rs. 500 37% 52% 43%
Rs. 501 - Rs. 1000 6% 0% 3%
Rs. 1001 - Rs. 2000 6% 0% 3%
> Rs. 2000 1% 0% 1%
No Response 45% 41% 43%
Total no. of respondents 71 58 129
126
Appendix 10: Practices for treatment of cold and cough for 6 - 36 month olds
Who was consulted by parents for advice or treatment?
Consulted for treatment / advice Percentage of Respondents
FW NFW Overall
Mitanin 29% 22% 26%
AWC 0% 3% 1%
ANM 1% 2% 1%
Male Health Worker 0% 1% 0%
Govt. Hospital 11% 14% 12%
Pvt. Doctor/Hospital 20% 26% 22%
Tantric 5% 0% 3%
Nobody 23% 27% 25%
Others 2% 5% 3%
No Response 14% 6% 11%
Total no. of respondents 133 100 233
Expenditure incurred for treating cold and cough
Expenditure on treating cold and cough Percentage of Respondents
FW NFW Overall
< Rs.100 9% 9% 9%
Rs.100 - Rs. 500 17% 29% 22%
Rs. 501 - Rs. 1000 2% 3% 3%
Rs. 1001 - Rs. 2000 1% 1% 1%
> Rs. 2000 1% 2% 1%
No Response 70% 56% 64%
Total no. of respondents 133 100 233
127
Appendix 11: Details of weight monitoring of children aged 0-3 years
Time when the newborn was first weighed after birth (0-6 months)
Time of first weighing of the newborn Percentage of respondents
FW NFW Overall
Immediately after Delivery 54% 54% 54%
Between 2 - 12 Hours 7% 7% 7%
Between 12 - 24 Hours 3% 5% 4%
Not Taken 29% 27% 28%
No response 7% 7% 7%
Total no. of respondents 69 41 110
Newborn was first weighed by
Newborn was first weighed by Percentage of respondents
FW NFW Overall
Mitanin 23% 15% 20%
ANM 10% 17% 13%
AWW 9% 7% 8%
Doctor 12% 10% 11%
Nurse 28% 27% 27%
Others 1% 0% 1%
No Info. 0% 2% 1%
No response 17% 22% 19%
Total no. of respondents 69 41 110
Status of weight monitoring in the month prior to the survey date (0-3 year olds)
Was the child weighed in the last month? Percentage of respondents
FW NFW Overall
Yes 73% 50% 64%
No 26% 47% 34%
No response 2% 3% 2%
128
Who weighed the child in the last month? (0-3 year olds)
Who shared the child’s nutri-tional status with the mother Percentage of respondents
FW NFW Overall
Mitanin 42% 10% 29%
Mitanin Trainer 26% 1% 17%
AWW 20% 40% 28%
ANM 3% 2% 2%
Other Mother 0% 0% 0%
Others 3% 1% 2%
No Response 25% 49% 34% *Multiple responses were possible thus totals may exceed 100%
After the child was weighed, was the mother informed about the child’s nutritional status? (0-3 year olds)
Was the mother informed about the child's nutritional status?
Percentage of respondents
FW NFW Overall
Yes 56% 36% 48%
No 33% 48% 39%
No response 11% 17% 13%
After weighing the child, who informed the mother of the child’s nutritional status (0-3 year olds)
Who shared the child’s nutritional status with the mother Percentage of respondents
FW NFW Overall
Mitanin 31% 12% 24%
Mitanin Trainer 23% 4% 16%
AWW 13% 25% 18%
ANM 2% 2% 2%
Other Mother 0% 0% 0%
Others 2% 0% 1%
No Response 40% 64% 49%
129
Nutritional status of the child, as shared with the mother
Was the child weighed in the last month? Percentage of respondents
FW NFW Overall
Normal 42% 31% 38%
Malnourished 11% 6% 10%
Don't know 6% 4% 5%
No response 40% 59% 47%
130
Appendix 12: Breast feeding practices (0-6 month olds)
Was the child given anything other than the mother’s milk within 3 days of birth?
Child given anything other than the mother’s milk within 3 days of birth or not Percentage of respondents
FW NFW Overall
Yes 25% 12% 20%
No 72% 85% 77%
No Resp. 3% 2% 3%
Total no. of respondents 69 41 110
What other than the mother’s milk, was the child given within 3 days of birth?
What other than the mother’s milk, was the child given within 3 days of birth? Percentage of respondents
FW NFW Overall
Milk (other than mother's) 65% 60% 64%
Normal Water 18% 0% 14%
Sugar / Glucose Water 6% 0% 5%
Tea 0% 0% 0%
Honey 0% 0% 0%
Janam Ghutti 12% 0% 9%
Others 0% 0% 0%
No response 24% 40% 27%
Total no. of respondents 17 5 22
131
Appendix 13: Age of Fulwaris on Survey Date
Sl. No. Block Panchayat name
Village name Para name Date of inaugura-tion of Fulwari
Date of sur-vey
Age of Fulwari at time of survey (days)
1 yq.Mªk djkSyh djkSyh Vksxjhikjk 16/09/2012 15-02-2013 152
2 eSuikV drdkyks drdksyk Mcjhikjk 17-12-2012 12-03-2013 85
3 lhrkiqj izrkix<+ izrkix<+ fVdjkikjk 20-12-2012 15-03-2013 85
4 yq.Mªk tjkdsyk jkbZ[kqnZ vkekikjk 10-12-2012 04-03-2013 84
eSuikV MkaxcqM+k MkaxcqM+k dqEgkjikjk c 19-12-2012 12-03-2013 83
6 eSuikV ueZnkiqj d.Mjktk cSxkikjk 21-12-2012 14-03-2013 83
7 lhrkiqj dquesjk dquesjk ek>hikjk 19-12-2012 11-03-2013 82
8 eSuikV mMwedsyk mMwedsyk ukokikjk 23-12-2012 14-03-2013 81
9 eSuikV MkaxcqM+k MkaxcqM+k [kkyikjk 24-12-2012 12-03-2013 78
eSuikV MkaxcqM+k MkaxcqM+k ek>hikjk 24-12-2012 12-03-2013 78
11 yq.Mªk djkZ djkZ vkekdksukikjk 20-12-2012 07-03-2013 77
12 yq.Mªk iqjdsyk flfdyek Åijikjk 12-12-2012 26-02-2013 76
13 crkSyh iksdljh iksdljh xksM+ikjk 17-12-2012 02-03-2013 75
14 vfEcdkiqj ldkyks ldkyks ek>kikjk 19-12-2012 04-03-2013 75
yq.Mªk djkZ djkZ cdjkrkyikjk 22-12-2012 05-03-2013 73
16 lhrkiqj jk;dsjk jk;dsjk izkKkikjk 19-12-2012 01-03-2013 72
17 lhrkiqj Hkwlw Hkwlw xsjkMkM+ mijikjk 20-12-2012 27-02-2013 69
18 yq.Mªk dsih dsih e>kjikjk 21-12-2012 26-02-2013 67
19 yq.Mªk mjnjk mjnjk cxhpkikjk 26-12-2012 03-03-2013 67
yq.Mªk mjnjk dksja/kk fcykjksdksuk 30-12-2012 06-03-2013 66
21 eSuikV drdkyks drdksyk <kiikjk 19-12-2012 23-02-2013 66
22 mn;iqj ejS;k flrdkyks [kjkZuxj 22-12-2012 25-02-2013 65
23 crkSyh egs'kiqj egs'kiqj :Mqdsyk 17-12-2012 18-02-2013 63
24 lhrkiqj lksurjkbZ ceyk;k cSxkikjk 19-12-2012 20-02-2013 63
crkSyh fpijdk;k fpijdk;k IkVsyikjk 31-12-2012
04-03-2013 63
26 yq.Mªk xqtjokj ilsuk enfj;k 20-12-2012 20-02-2013 62
27 lhrkiqj lksurjbZ lksurjbZ lqxoklqikjk 20-12-2012 19-02-2013 61
28 mn;iqj isUMj[kh cdksbZ eqankjkMkMikjk 24-12-2012 22-02-2013 60
29 vfEcdkiqj lqUnjiqj lqUnjiqj ca/kokikjk 27-12-2012 25-02-2013 60
eSuikV ljHkatk ljHkatk MqejxksMk 13-01-2013 14-03-2013
60
31 vfEcdkiqj lqUnjiqj lqUnjiqj lsejikjk 26-12-2012 23-02-2013 59
32 eSuikV ijifV;k ijifV;k gjkZ<ks<+h 15-01-2013 14-03-2013 58
33 crkSyh eVdks eVdks ijlkM+kM 20-12-2012 15-02-2013 57
34 yq.Mªk ykyekVh ykyekVh egknsoMqxq 04-01-2013 02-03-2013 57
mn;iqj ekuiqj ekuiqj clksjikjk 23-12-2012 17-02-2013 56
36
lhrkiqj nsox<+ nsox<+ egqvkFku ¼isjok
ikjk½
28-12-2012 22-02-2013
56
37 mn;iqj [kEgfj;k [kEgfj;k
?klh;kikjk
¼[kkyikjk½ 30-12-2012 24-02-2013 56
38 yq.Mªk dksbZykjh fdjfdek Mqej[kkSyh 29-12-2012 21-02-2013 54
39 vfEcdkiqj lqUnjiqj lqUnjiqj taxyikjk 29-12-2012 20-02-2013 53
eSuikV lqiyxk lqiyxk ljnkjikjk 29-12-2012 20-02-2013 53
41 mn;iqj rksyxk tkeMhg Ldwyikjk 08-01-2013 02-03-2013 53
42 eSuikV dqfu;k dqfu;k Hknj fVdjk 20-01-2013 14-03-2013 53
43 vfEcdkiqj djkZ djkZ rqjhZMkM [kkyikjk 29-12-2012 18-02-2013 51
44 lhrkiqj jtiqjh jtiqjh >qejkikjk 11-01-2013 03-03-2013 51
lhrkiqj fHkBqok fHkBqok dqEgkjikjk 02-01-2013 21-02-2013 50
46 mn;iqj lk;j lk;j Ldqyikjk 28-12-2012 15-02-2013 49
47 vfEcdkiqj cM+k nekyh cM+k nekyh ilsukikuh ikjk 29-12-2012 16-02-2013 49
48 crkSyh rsykbZ/kkj rsykbZ/kkj Åijikjk 04-01-2013 22-02-2013 49
132
49 y[kuiqj t;iqj t;iqj [kkyikjk 30-12-2012 17-02-2013 49
vfEcdkiqj fNUndkyks fNUndkyks fpvkWaikjk 30-12-2012 16-02-2013 48
51 mn;iqj dypk dypk ifudkikjk 11-01-2013 28-02-2013 48
52
mn;iqj ljxoka ljxoka cgjkikjk 10-01-2013 27-02-2013 48
53 vfEcdkiqj iksM+hdyk iksM+hdyk NksVsikjk 10-01-2013 27-02-2013 48
54 mn;iqj lk;j lk;j iVsyikjk 28-12-2012 13-02-2013 47
55 y[kuiqj rqjuk rqjuk cSxkikjk 30-12-2012 15-02-2013 47
56 mn;iqj ejS;k flrdkyks rqjkZikjk 11-01-2013 27-02-2013 47
57 crkSyh fo'kquiqj fo'kquiqj ckokikjk 11-01-2013 26-02-2013 46
58 yq.Mªk lsejMhg lsejMhg cgsjkikjk 03-01-2013 18-02-2013 46
59 mn;iqj dypk dypk gfjtuikjk 11-01-2013 26-02-2013 46
60 yq.Mªk dksfjek cklk txyikjk 15-01-2013 01-03-2013 45
61 y[kuiqj rqjuk rqjuk Vhdjkikjk 30-12-2012 13-02-2013 45
62 eSuikV lefu;k lefu;k e>okjikjk 04-01-2013 18-02-2013 45
63 mn;iqj 'kadjiqj 'kadjiqj tikuikjk 12-01-2013 25-02-2013 44
64 vfEcdkiqj ekfud
izdk'kiqj
ekfud
izdk'kiqj
?kqejkikjk 03-01-2013 16-02-2013 44
65 vfEcdkiqj jdsyh jdsyh jtokjikjk 11-01-2013 24-02-2013 44
66 y[kuiqj ySxk ySxk ¼iFkjbZ½ dVsyikjk 11-01-2013 21-02-2013 41
67 vfEcdkiqj iaikiqj iaikiqj [kqBsuikjk 16-01-2013 26-02-2013 41
68 yq.Mªk dduh dNkj [ktqjikjk 15-01-2013 23-02-2013 39
69 mn;iqj dqEkMsok dqEkMsok lyckikjk 18-01-2013 25-02-2013 38
70 y[kuiqj xsrjk xsrjk /kfl;kikjk 17-01-2013 23-02-2013 37
71 lhrkiqj <syljk <syljk lhdrkikjk 17-01-2013 23-02-2013 37
72 crkSyh fpjaxk fpjaxk gfjtuikjk 14-01-2013 18-02-2013 35
73 y[kuiqj mejkSyh t;iqj ¼>kcj½ cSxkikjk 13-01-2013 17-02-2013 35
74 lhrkiqj xqrqjek fYkfpjek gfjtu ikjk 15-01-2013 19-02-2013 35
75 lhrkiqj lwj lwj dfj;klwj mi-
jikjk
13-01-2013 17-02-2013 35
76 y[kuiqj [kqfV;k [kqfV;k lsesjikjk 10-01-2013 13-02-2013 34
77 mn;iqj dslek dslek [kklikjk 18-01-2013 20-02-2013 33
78 y[kuiqj xqexjkdyk xqexjkdyk [kkyikjk 14-01-2013 15-02-2013 32
79 crkSyh fpjaxk fpjaxk
igkMfpjaxk
¼Ldwyikjk½
13-01-2013
13-02-2013 31
80 eSuikV fcljikuh fcljikuh iz/kkuikjk 20-01-2013 16-02-2013 27