Data: While NFHS-5 Indicates Progress on Nutrition Related Indicators, Some Districts are Far Behind the Curve - FACTLY
Sai Krishna Muthyanolla
September 7, 2023
The National Family Health Survey (NFHS) reports provide data on nutrition-related indicators. As per NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16) at the national level with the share of Stunting, Wasting, and Underweight prevalence, all recording a reduction. However, some districts are far behind the curve.
Malnutrition is a pressing global health issue affecting millions of children, especially in low and middle-income countries. It is an important indicator of nutritional status and health in populations as it is a sign of bigger issues like insufficient access to nutritious food, poor maternal health, inadequate healthcare, poor sanitation, and socioeconomic disparities. The presence of malnutrition in a child signals potential vulnerabilities in their immune system, growth potential, and cognitive development.
According to a Lancet study published in 2019, in India, malnutrition was the predominant risk factor for death in children younger than five years of age in every state of India in 2017, accounting for 68.2% of the total under-five deaths, and the leading risk factor for health loss for all ages, responsible for 17.3% of the total disability-adjusted life years. Even though there has been considerable progress made by governments in addressing the multifaceted problem, malnutrition continues to cast a shadow over India’s progress.
NFHS Reports provide data on nutritional status
The National Family Health Survey (NFHS) reports provide data on nutrition-related indicators. The NFHS is a large-scale, nationally representative survey conducted in India to collect data on various aspects of population and health. It is one of the most comprehensive and authoritative sources of information on demographic and health indicators in the country. The NFHS is carried out by the Ministry of Health and Family Welfare, Government of India, with technical support from various organizations, including the International Institute for Population Sciences (IIPS) and other international agencies.
Wasting, stunting, and being underweight are generally used to describe different forms of malnutrition and growth problems in children. These conditions are often used as indicators of a child’s overall nutritional status.
Overall, there has been improvement in child nutrition indicators at the national level, but trend varies across districts
As per NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16). Stunting has reduced from 38.4% to 35.5%, Wasting from 21.0% to 19.3%, and Underweight prevalence from 35.8% to 32.1%.
However, the trend is not uniform across districts. The NFHS provides district-level data on the percentage of children under 5 years of age who are stunted, wasted, severely wasted, and underweight. In this story, we look at some of the best and performing districts in each of these indicators which helps in understanding how the variance in performance is, compared to the national level figures. The data for this story has been taken from Dataful.
Stunting – 1 in 2 children were stunted in 17 districts
District-level data indicates that Mahe (Puducherry) and Kullu (Himachal Pradesh) recorded the largest increase in the share of stunted children, by nearly 17 percentage points between both surveys. Mumbai Suburban (Maharashtra) and Longding (Arunachal Pradesh) saw an increase of nearly 16 percentage points. Out of nearly 570 districts for which data is available from both surveys, around one-third had recorded an increase in the share of stunted children. Meanwhile, Bhopal (Madhya Pradesh) registered a decline from 47.6% to 19.9% during this period.
More than 50% of the children under 5 were stunted in 17 districts. Six of these were in Uttar Pradesh, 2 each in Jharkhand, Bihar, Meghalaya, and Gujarat, and one each from Chhattisgarh, Andhra Pradesh, and Karnataka. The highest share was in Jharkhand’s Pashchimi Singhbhum where more than 60% of the children were stunted. Only 3 districts recorded less than 15% of children in this category. These are Puri and Jagatsinghapur (Odisha) and Lower-Dibang-Valley (Arunachal Pradesh). About 30 districts recorded less than 20%, of which the majority were from Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, Punjab, Manipur, and Odisha.
Wasting- Every other child in Karimganj is wasted
While 1 in 5 children under 5 years of age are wasted at the national level, district-level data indicates that in Karimganj (Assam), nearly every other child is wasted. In fact, the district, where this share was less than 18% when NFHS -4 was conducted has recorded an increase by more than 30 percentage points in the five years. The Dangs (Gujarat) also recorded more than 40%. Out of 14 districts where 1 in 3 children are wasted, 4 each were from Bihar and Gujarat, 3 from Maharashtra, 2 from Telangana, and 1 from Assam. Andhra Pradesh’s overall share of wasted children stood at 16.1%, less than the national value.
North-District (Sikkim) is the only place to have recorded less than 5% of children in this category. 16 districts recorded less than 8% of which the majority were from Northeastern states and Punjab.
Around 40% of the districts recorded an increase in the share of wasted children. Tehri Garhwal (Uttarakhand) saw a decline in wasted children by 34 percentage points. 10 other districts recorded a decline of more than 20 to 30 percentage points.
Severe Wasting – More than 20% children were severely wasted in 6 districts
Globally, at least 13.6 million children under the age of 5 suffer from severe wasting, which is responsible for 1 in 5 deaths among children under age 5, making it one of the top threats to child survival. A severely wasted child is up to 11 times more likely than a healthy child to die of common childhood illnesses such as pneumonia, the single largest infectious cause of death in children worldwide, according to UNICEF. Sadly, 7.7% of the children in India are severely wasted as per NFHS-5, up from 7.5% in NFHS-4.
Among districts, the prevalence varied from 0.5% in Mon (Nagaland) and 1% in (Ludhiana) to more than 30% in Karimganj (Assam). Apart from Karimganj, five districts reported a prevalence of more than 20%. These are Saraikela-Kharsawan (Jharkhand), The Dangs (Gujarat), Chandrapur and Nagpur (Maharashtra), and Sheohar (Bihar). 405 districts out of more than 700 for which data is available had a prevalence less than what is reported at the national level. Of the best performing 17 districts with a prevalence of 2% and below, 4 were from Odisha, 3 from Uttar Pradesh, and 2 from Punjab.
Nearly 49% of the districts saw an increase in the prevalence of severely wasted children. While Karimganj recorded an increase in prevalence by more than 24 percentage points, Sheohar reported an increase of more than 17 percentage points. 4 districts from Jammu and Kashmir, 2 each from Bihar and Uttar Pradesh also recorded a rise by more than 11 percentage points.
Underweight – 1 in 2 children were underweight in 12 districts
Pashchimi-Singhbhum (Jharkhand) which recorded the highest prevalence of stunted children also recorded the highest share of underweight children under five years of age. About 62% of the children there were underweight. The Dangs in Gujarat and Assam’s Karimganj were also among the districts with a high prevalence of underweight children. Out of the 12 districts that reported more than 50% prevalence, 5 were from Gujarat, and 2 were from Jharkhand.
While at the national level, about 1 in 3 children under five were underweight, in 3 districts of Arunachal Pradesh and South District of Sikkim, their share was only between 7 to 9%. In nearly 60% of the districts, the prevalence was less than that reported at the national level. Zunheboto (Nagaland) saw a rise in prevalence by nearly 31 percentage points between the two surveys while Dungarpur & Udaipur (Rajasthan), and Guna (Madhya Pradesh) saw a decline by more than 25 percentage points.
Data calls for localized approach to deal with malnutrition
There are many schemes being implemented by the Government of India like Anganwadi Services, Scheme for Adolescent Girls, and Pradhan Mantri Matru Vandana Yojana (PMMVY) under the Umbrella Integrated Child Development Services (ICDS) Scheme as direct targeted interventions to address the problem of malnutrition in the country. Children with Severe Acute Malnutrition are treated at the Nutrition Rehabilitation Centres established by the Ministry of Health and Family Welfare. However, the data calls for a localized approach to deal with the issue.