AN ASSESSMENT OF THE PREVALENCE OF ACUTE MALNUTRITION
IN THE DISTRICT OF KACHCHH, GUJARAT, INDIA
PHOTO
BY
WORLD FOOD PROGRAMME
With Support of the
THE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT
SOCIETIES
SAVE THE CHILDREN
OXFAM
MARCH 2001
1
Contents:
Page:
Summary
3
Recommendations
4
Introduction
5
Aim and Objectives
7
Timeframe
7
Target Group
7
Sampling
7
Data Collection Tools
9
Data Collection Method
10
Data Analysis
10
Results
11 to 19

General Information
11

Anthropometric Results
14

Supporting Data
15
Discussion
20
References
22
ANNEX
1 Cluster sampling
2 Selection of villages
3 Time Line for Survey
4 Questionnaire for data collection
2
Summary:
The District of Kachchh, in the western most part of the State of Gujarat, has suffered a
continuing drought for the last two years. On 26 January 2001, a severe earthquake hit the
district causing widespread devastation. These factors may have caused a high degree of
food insecurity in the district. Two separate surveys conducted before the earthquake
indicated that a large proportion of pre-school children living in the State of Gujarat are
wasted (16.2%, among children under 3 years (NFHS-2, 1999); 29.5%, among children aged
12-59 months, National Institute of Nutrition, 2000).
The aim of this survey was to determine the prevalence of acute malnutrition in the District of
Kachchh. The survey was implemented by the International Federation of Red Cross and
Red Crescent Societies, the World Food Programme, Save the Children and Oxfam. Its focus
was to use the anthropometric measurements of weight and height as the prime determinants
of the level of acute malnutrition in the district and to establish baseline nutritional data,
which could be used to target and plan assistance, as well as to determine the impact of this
assistance. This survey also aimed to collect quantitative information to support the
anthropometric data. Hence a questionnaire was designed to collect information on the
prevalence of diarrhoea and respiratory infections, breast-feeding and the effect of the
earthquake on food intake.
The survey was conducted between the 5 to 26 March 2001 inclusive. It targeted children
aged between 6 to 59 months as a proxy for the rest of the population. Anthropometric
measurements were taken from a total of 798 children randomly sampled through out the
District of Kachchh. A caretaker of each child was also interviewed to obtain basic
information on the prevalence of diarrhoea and respiratory infections, food intake since the
earthquake, level of breast-feeding and registration at Anganwadi Centres
The nutritional index of weight for height, the statistical description of Z-scores and
International Reference Values (NCHS/CDC) were used to interpret the anthropometric data
collected by this survey. The global level of acute malnutrition in the District of Kachchh
was found to be 20.5%, where 17.7% of the sampled children were found to have moderate
acute malnutrition and 2.8% severe acute malnutrition. The prevalence of moderate and
severe acute malnutrition was significantly higher among children under the age of 3 years
and overall, the levels of malnutrition were higher among girls than among boys. This
difference was significant in children under 3 years of age, but not in older children. Also, the
rate of acute malnutrition was higher in rural than urban areas of the district.
More than three out of every four caretakers reported that the food intake of the children
under their care had remained the same since 26 January. About 20% reportedly had
decreased their intake, while 3% consumed more.
Approximately one third of the sampled children were reportedly registered with an
Anganwadi Centre (AWC). Nearly 60% of these children were receiving supplementary
food at the Anganwadi centres. Taking into account distribution by NGOs, 81% of all
children registered at an AWC received supplementary feeding. At the time little over 95%
of this food consisted of biscuits. Registration of urban children and children younger than
three in these centres was significantly less common then of rural and/or older children. The
prevalence of malnutrition among children who were not registered at an AWC was
significantly higher than among children registered.
3
About one quarter of the children sampled was reported to have had diarrhoea in the two
weeks prior to this survey and one third had suffered a respiratory infection. These children
were found to be significantly more likely to be registered at an Anganwadi Centre than
children, who had not experienced these conditions in the two weeks prior to the assessment.
The prevalence of malnutrition among children who had recently suffered from diarrhoea was
higher than among children who had not suffered from diarrhoea. Malnutrition among
children who had experienced a respiratory infection did however not significantly differ
from children without an episode of such an infection.
This assessment also found a link between hygiene and the incidence of diarrhoea and
respiratory infections. Children who were infrequently bathed or lived in a household whose
main source of water was a pond were more likely to have had diarrhoea or a respiratory
infection in the two weeks prior to the survey.
It is recommended that the results of this survey are interpreted in conjunction with those of
an in-depth qualitative food insecurity and vulnerability profile of the State of Gujarat.
Results of this assessment conducted by the World Food Programme, UNICEF, IFAD and
Catholic Relief Service, emphasis the need to improve livelihood through a number of
comprehensive interventions. Nevertheless, the results of this assessment have generated the
following recommendations:
Survey Recommendations:
1. Support the restoration and the activities of the Integrated Child Development Service
(ICDS) of the Department of Health of the State of Gujarat through its Anganwadi
Centres. This might include:
a) (Continue to) assist in re-establishing functioning Anganwadi Centres throughout the
District of Kachchh, if need be involving NGOs in areas presently not covered.
b) Continue to provide the Anganwadi Centres with supplementary food, so that a
greater proportion of people are able to receive it compared to the current level; in
particular the focus should be on extending the services of the ICDS to all malnourished
children in the village.
c) Intensify training and supervision of Anganwadi workers with the aim to further
strengthen their skills in growth monitoring, the provision of health education and
promotion, in particular to prevent diseases of poor hygiene, and nutrition education,
including the promotion of good breast-feeding and weaning practices. Also, the
importance of including adolescent girls in health and nutrition education should be
further stressed.
e) Explore various modalities to provide incentives that would increase the outreach to
children below 3 years of age, who at present are not registered, to include these children
in growth monitoring and target their mothers/caretakers for health and nutrition
education.
f) Encourage Anganwadi workers to increase out-reach activities –also in hamlets- to track
malnourished children, in particular girls under three, to be registered for supplementary
4
feeding in the centres regardless of fulfilling other criteria until such time an adequate
nutritional status is reached.
g) Raise awareness about the importance of Anganwadi Centres in the community and
develop mechanisms for the involvement of the community in the functioning of these
centres.
h) Strengthen the linkage between the Anganwadi Centres and the grass root health facilities
(primary health centres and sub-centres) to promote nutritional surveillance and
appropriate management of children with malnutrition, in particular those who are
severely malnourished, in the district of Kachchh
2. Further investigate intra household and consumption patterns, food habits, care and other
factors that might explain why girls are more likely to be malnourished than boys.
3. Conduct comparable follow-up surveys every year in order to, among others, measure
change.
5
Introduction:
On the 26 January 2001, a severe earthquake - the worst in 50 years - hit the State of Gujarat,
India. The epi-centre was close to the town of Bhuj in the District of Kachchh, which lies in
the westernmost part of the State Of Gujarat. Death tolls, as a result of the earthquake are
estimated to be higher than 20,000 people with many more injured. The destruction of
private and public property is enormous.
The State of Gujarat, with a population of about 50 million people, has suffered a continuing
drought for the last two years. In combination with a number of other factors, this may have
led to a high degree of food insecurity in a number of the districts of the State, including the
district of Kachchh. A 1998-99 National Family Health Survey report and a recent
assessment conducted by the National Institute of Nutrition, India indicate high levels
wasting among pre-school children living in the State of Gujarat.
The Integrated Child Development Service (ICDS) of the Department of Health of the State
of Gujarat, through its Anganwadi Centres, provide supplementary food, preschool education
to children, health check ups and referral services, as well as nutrition and health education to
women aged between 15 to 45 years. The earthquake has destroyed most of the facilities of
Anganwadi Centres and many of their activities have come to a halt. It is therefore feared
that the already precarious situation of those children with a propensity to malnutrition in
Kachchh District has worsened. On the basis of these considerations and in order to identify
needs, it was decided to conduct a nutritional survey to determine the prevalence of acute
malnutrition in the district of Kachchh.
This survey was implemented by the World Food Programme with support of the
International Federation of Red Cross and Red Crescent Societies (Federation), Save the
Children (SC) and Oxfam. Anthropometry was the prime method used by this survey in the
determination of acute malnutrition. The focus of this survey was to determine the ‘effect’ of
the current situation on the nutritional status of people living in the district of Kachchh, as
opposed to determining ‘cause’.
In addition to this anthropometric survey, WFP, UNICEF, IFAD and Catholic Relief Service
(CRS) concurrently conducted a community level assessment in the state of Gujarat, with the
goal to form a food insecurity and vulnerability profile of the state, which aimed to highlight
the following:
1.
Identification of food insecure households
2.
Information on household shelter
3.
Pre and post shock household food security
4.
Intra household food distribution and its impact on nutrition
5.
Identification of food gaps at the household level
6.
Seasonal variation/Coping Strategies
7.
Knowledge and practices on health and nutrition among women
8.
Institutional/Stakeholders’ analysis
9.
Information on various ongoing programmes and their outreach
10.
Programme recommendations and potential roles of food aid as an enabling agent and
who are the NGO partners that would be effective.
6
In order to prevent duplication, the Federation/WFP/SC/Oxfam nutrition survey did not
assess any of the factors determined by WFP/UNICEF/CRS food insecurity and vulnerability
profile assessment. Both surveys complement each other and conclusions have been drawn
from the interpretation of both sets of results, separately as well as in conjunction.
Aim:
To determine the level of acute malnutrition in the district of Kachchh, India.
Objectives:
1. To determine the level of acute malnutrition among children aged 6 to 59 months living
in the district of Kachchh by the use of anthropometric measurements.
2. To establish baseline nutritional data which can be used to target and plan assistance and to
determine the impact of this assistance
Time frame:
This survey was conducted between 05.03.2001 to 26.03.2001 inclusive. This period
included the time necessary to determine the survey’s methodology, train its data collectors,
enter, clean and analyse data, as well as produce this report. The survey’s data collection
phase took place between 14.03.2001 and 17.03.2001 inclusive.
Target group:
The target group for this survey was children aged 6 to 59 months. Children in this age group
are undergoing a period of rapid growth and so are very sensitive to any nutritional stress.
They are sentinel to any nutritional problems within a community and the most effective
group to target to determine the level of malnutrition in a community.
Sampling: (refer to the Annex of this report for more detailed information)
As the recent earthquake in the District of Kachchh has affected the accuracy of the register
of the local population, 2-stage cluster sampling was the sampling method of choice for this
survey1.
1. Determination of geographical units and their population:
WFP/UNICEF/IFAD/CRS, in their food insecurity and vulnerability profile assessment, had
already determined the population size of the urban and rural areas in each of the nine blocks
(talukas) in the district of Kachchh. The projected increase in population since the Census in
1991 is 18%. This information was used to update Census 1991 population figures for each
taluka. For the first stage of the sampling, this information was used to determine the number
of clusters per taluka stratified for urban/rural. First stage sampling was thus in both urban
and rural areas in direct proportion to the population (proportional to size).
1
The 2 stage cluster sampling method used by this survey followed the guidelines as outlined in the
publication: Medecins Sans Frontieres, (1995): Nutrition Guidelines 1st edition; Medecins Sans Frontieres,
Paris.
7
2. Calculation of the sample size:
No known data exists on the prevalence of acute malnutrition in the district of Kachchh,
therefore the size of the sample required for this survey was calculated using the following
equation, with an estimated prevalence (p) of malnutrition in the target group of 0.5:
n = t2 x p ( 1 - p)
d2
n = sample size
t = error risk = 1.96 for an error risk of 5%
p = expected prevalence of malnutrition = 0.5
d = absolute precision = 0.05
The survey’s required sample size, as determined by this equation, was 384. However as
individuals living in the same area tend to share similar characteristics (design effect), the
sample size, as determined above, was doubled to account for this. Therefore, the survey’s
required sample size was 768.
The sample consisted of 30 clusters to keep the design effect below 2, in line with standard
practice. The number of children sampled from each cluster was thus 26 (i.e. 768 divided by
30).
3. Calculation of the sampling intervals
This was determined by dividing the total population first of the whole districts, then per
taluka by the number of clusters required.
4. Determination of the location of the first cluster and the selection of the clusters:
The location of the first cluster was randomly selected using a random number table. The
sampling interval was added to this random number to determine the location of the next
cluster. The procedure was repeated within each taluka in order to determine the precise
ward or village in which the cluster was located.
5. Selection of children in the clusters:
Once the location of each cluster had been determined, they were divided among the data
collectors. On arrival in each ward/village the data collectors were trained to identify and
locate the various social and religious groupings living in that locality. The aim was to keep
selection bias (in relation to gender, caste, religion etc.) to an absolute minimum. The
number of children aged 6 to 59 months, drawn from each ‘segment’ of the community, was
in proportion to their population size.
Data collectors began their data collection in the centre of each ‘segment’. A random
direction was picked by spinning a bottle and following the direction as indicated by the
bottle-neck. The data collectors randomly selected households situated in that direction. The
first household was selected from among these households by drawing a random number.
Subsequent households were chosen by proximity until the required number of children had
been selected and all data had been collected. All eligible children were included in this
survey.
8
Data Collection Tools:
1. Anthropometric Measurements:
a) Weight
The weight of all children aged 6 to 59 months, included in the survey’s sample, was
measured and recorded by data collectors trained to take accurate anthropometric
measurements. Weighing scales, capable of measuring weight in kilograms to the nearest
100g, were used.
b) Height/Length
All children included in the sample, under the age of 24 months, had their length measured
using a length measuring board. For children over the age of 24 months, height was
measured using a standing height measuring board. All the length/height measuring
apparatus used by this survey was capable of measuring to the nearest 0.1 cm. Again trained
data collectors were responsible for taking these measurements.
If the age of the child was difficult to assess, data collectors were trained to measure children
of less than 85 cm lying down, whilst children of over 85 cm were measured standing up.
c) Nutritional Oedema
All data collectors were taught to determine the presence of nutritional oedema (retention of
fluid) The child was determined as having nutritional oedema if a shallow print or pit
remained when normal thumb pressure was applied to the foot or lower leg of the child for
three seconds and then the thumb was lifted Any child found to have nutritional oedema was
classified as malnourished.
d) Age
During the preparation and piloting phases of this survey, there was some debate as to
whether it would be possible to obtain an accurate age of each child included in the sample.
Due to the short time frame of this survey, it was decided not to use a ‘local calendar’ to
collect age data. It was felt this would be too time consuming to train data collectors in its
correct application and would significantly increase the time needed to collect the required
data. Also, as a decision had been made to use weight for height as the nutritional index of
acute malnutrition, it was felt that collecting age data was not a priority of this survey.
Nevertheless, it was decided to attempt to collect this data.
2. Quantitative Questionnaire
A simple, short quantitative questionnaire was developed for use in this survey. Its aim was
to complement the collected anthropometric data by providing information on the current
prevalence of diarrhoea and respiratory infections. These conditions are known to have a
negative impact on nutritional status. They are hypothesised to be prevalent in the district
due to the effect of the drought on water supply and disruption to housing caused by damage
to accommodation as a result of the earthquake. The questionnaire also gathered information
on breast-feeding, the effect of the earthquake on food intake, and supplementary feeding
provided to children registered at AWCs.
All the survey’s data collection tools were piloted in an urban and rural area of the district
before the start of the data collection phase. The pilot phase indicated that in some cases, it
was possible to collect accurate age data and in others, it was difficult to ensure its accuracy.
In light of these findings, it was decided to collect age data during the actual data collection
phase of this survey, but to also include an additional question in the survey’s questionnaire
to record the source of this information.
9
Data Collection Method:
30 data collectors were recruited to collect the data required by this survey. The criteria for
their selection were:
1. Completed at least secondary level education.
2. Ability to speak the local language and a good knowledge of the culture of the District of
Kachchh.
3. Good communication skills with an ability to ask questions in a friendly, open manner.
4. Ability to collect and record information accurately and clearly.
5. Ability to travel throughout the district of Kachchh.
Each data collector attended and participated in a two day training programme, where they
were taught how to take and record the anthropometric measurements required by this survey,
and how to complete the survey’s quantitative questionnaire. The questionnaire was
developed in English, then translated into Gujarati. It was then back translated into English to
ensure the accuracy of its translation.
The data collectors were divided into ten groups, each consisting of three people. Each group
was given a set of weighing scales, a height/length measuring board and quantitative
questionnaires to complete. Each group was designated areas (as determined by the sampling
methodology) in which to collect the survey’s data.
Data collection took four days to complete.
Data Analysis:
The aim of this survey was to determine the level of acute malnutrition in the District of
Kachchh. The nutritional index weight for height was used, by this survey, in this
determination. The weight for height index expresses the weight of a child in relation to his
height. It is a measure of acute malnutrition. It was chosen in preference to the weight for
age index, as the latter does not differentiate between children of the same age and weight
where some are tall and wasted and some are short and not wasted. The weight for age index
is useful as a continual measure of nutritional status (i.e. over time). It is frequently used in
Maternal Child Health Clinics for nutritional/growth surveillance. Weight for height,
however is a useful and arguably a better index to gain a one-off snapshot of the prevalence
of acute malnutrition. Also it has the advantage of not requiring age in its determination,
which can be difficult to accurately obtain.
All collected data was analysed using EPI-INFO/EPI-NUT computer software. EPI-NUT
was used to process the anthropometric data. In line with international recommendations by
WHO and the minimum standards in disaster response2, International Reference Standards
(NCHS/CDC)3 were used and Z-scores determined4. Those children found to have a Z-score
2
The Sphere Project, Humanitarian Charter and Minimum Standards in Disaster Response.
3
The debate about the validity and usefulness of using international standards for measuring acute
malnutrition has been effectively closed since 1984. Since then their use has rapidly gained momentum and
presently virtually all countries in the world, including India, use the NCHS/CDC reference standards.
4
A Z-score is a score of the standard deviation from the median of a reference population.
Z-scores were chosen in preference to percentiles or percentage of reference median. Percentage of reference
median has the disadvantage of having variations in its meaning according to age i.e. “...a child is more
malnourished if the weight/height index is 80% at 6 months than at 59 months...” (MSF,1995). The statistical
description of percentiles does not allow severely malnourished children to be identified as there are no
percentiles in the reference population that correspond to children in this category (MSF, 1995). Therefore the
statistical expression of Z-scores is believed to allow the best interpretation of nutritional indices such as weight
for height. Table 3 outlines how each Z-score should be interpreted.
10
below -2 but greater than -3 Z-scores were classified as having moderate acute malnutrition
and those with a Z-score of less than -3 or with oedema were classified as severely
malnourished. Table 1 summarises this classification.
Table 1:
Weight for Height Z-Score
Less than -2 Z-scores but greater than -3 Z-scores
Less than -3 Z-Scores or oedema
Less than -2 Z-scores or oedema (equivalent to the
addition of the values obtained for moderate and
severe acute malnutrition).
Interpretation
Moderate Acute Malnutrition
Severe Acute Malnutrition
Global Acute Malnutrition
EPI-INFO was used to analyse the data collected by this survey’s quantitative questionnaire.
This included the calculation of the correlation between variables (Odds Ratios). Statistical
significance was determined at the 95% level of significance.
Results:
A) General Information
Data from a total of 798 children aged 6 to 59 months were collected by this survey. 54.6%
of these children were boys. This percentage complies with the reported gender ratio in the
District of Kachchh, which is 1066 boys to 1000 girls (equivalent to a percentage breakdown
of 53.3% boys and 46.7% girls) (WFP, 2000). Table 2 displays the proportion of children
sampled from each Taluka and compares it to the number required fulfilling the criteria of the
sampling methodology of this survey. Table 2 also displays the proportion of boys and girls
sampled in each Taluka, expressed as a percentage of their total number in the entire sample.
The actual sample size (n=798) was slightly higher than the required sample size of 768 due
to extra sampling of children by the data collectors in some of the contingency areas
designated for sampling (as denoted by an asterix in the sampling section of the Annex of this
report)5.
Table 2:
Taluka
Rapar
Mandvi
Nakhatrana
Bhuj
Abdasa
Bha Chau
Anjar
Lakhpat
Mundra
Total
5
Boys
n=
%=
62
14.2
40
9.2
51
11.7
91
20.9
30
6.9
40
9.2
90
20.6
13
3
19
4.4
436
100
Girls
n=
%=
42
11.6
38
10.5
29
8
93
25.7
24
6.6
43
11.9
68
18.8
13
3.6
12
3.3
362
100
Total
Required Total (No of clusters)
104
78
80
184
54
83
158
26
31
798
104 (4)
78 (3)
78 (3)
182 (7)
52 (2)
78 (3)
156 (6)
26 (1)
26 (1)
780 (30)
Please note: It was not possible to analyse the collected data at the individual taluka level. The
sampling methodology for this survey had been devised to obtain a statistically representative result for acute
malnutrition at the district level and not at an individual taluka level. To obtain statistically valid information at
the taluka level would have required a much larger sample, more time and was, in fact, beyond the objectives of
this survey
11
The sample was compared to data from the 1991 census regarding religion and scheduled
caste. In comparison, Jains were under-represented, while the proportion of Muslims was
higher than expected. The latter might be the result of a relatively higher birth rate among
Muslims than among other groups during the last ten years (preliminary figures census
2001Gujarat). Under-representation of Jain could be possibly explained by the fact that this
group relatively more often belongs to the better of strata of society, and therefore could
afford to move away from the affected areas to Mumbai or Ahmedabad6.
Table 3:
Sample
Census 1991
Scheduled tribe
18.7%
19.2%
Hindu
73.8%
75.4%
Muslim
25%
20%
Jain
1.1%
4.6%
Christian
0.12%
0.17%
Results of the data collection of age indicate that less than 50% of the respondents could
prove the age of the child in writing (e.g. by card) or confirmed the date of birth orally. In
fourteen cases (1.8% of the sample), the respondent was unable to give an age of the sampled
child. Table 4 illustrates that the majority of dates of births collected during this survey were
estimates.
Table 4:
Accuracy of date of birth of child
Shown card
Estimated
Oral confirmation
Unable to give an age
Total
Frequency
187
412
185
14
798
Per cent
23.4
51.6
23.2
1.8
100
In view of these findings and considering that the main aim of the survey was to determine
the prevalence of acute malnutrition, it was decided not to analyse nutritional indices such as
height for age (an index of chronic malnutrition) which requires an accurate age in months in
its calculation. The collected age data were however used to subdivide the sampled children
into different age groups.
6
Source: Rapid Assessment of Earthquake Affected Areas in Gujarat, Kachchh Navnirman
Abhiyan a.o.
12
The ‘estimated’ age groupings of these children are displayed in Figure 1.
Figure 1:
Age Groups of the Sample
Boys
Percent of sample
20
15
10
5
0
06 to 12
19 to 24
13 to 18
31 to 36
25 to 30
43 to 48
37 to 42
49 to 59
Age (months)
Figure 2 illustrates the distribution of the respondents’ relationship to the children sampled
during the survey. In the majority of cases (67.6%), the person interviewed during this
assessment was the child’s mother. The second most frequent respondent was the child’s
father, followed by the child’s grandparent.
Figure 2:
Relationship of Respondent to the Child
4.8%
4.4%
1.9%
Mother
9.0%
Father
Grandparent
Aunt/Uncle
12.3%
Sibling
67.6%
Other
Urban/Rural
The proportion of the entire sample living in rural areas was 71.4% (n=571). This complies
with the sampling methodology developed for this survey i.e. 21 clusters of 26 children
(equivalent to n= 546) were taken from rural clusters.
13
B) Anthropometric Results
As outlined in the sections on data collection method (page 9) and analysis (page 10) the
nutritional index weight for height was used by this survey to determine the prevalence of
acute malnutrition in the District of Kachchh. Findings were as follows:
Global Malnutrition 20.5%
Moderate Malnutrition 17.7%
Severe Malnutrition 2.8% of which 0.8% oedema
Statistical analysis indicates that acute malnutrition was significantly higher among girls than
boys (OR = 1.66; [1.06 – 2.60]7). Also, the prevalence of acute malnutrition among children
under 3 years was found to be significantly higher then among their older counterparts. (OR
= 1.63; [0.99- 2.71]). A further break-down reveals that, in this survey, in particular female
children aged less than three years of age were more likely to be malnourished then boys in
the same age group (OR = 2.11; [1.24 – 3.61]). The difference between boys and girls was
not significant in the group aged 36-59 months. (OR = 1.06; [0.44 – 2.60]). Tables 5 and 6
display the proportion of children found to be malnourished broken down by age group and
sex.
Table 5:
Age group
(months)
Moderate Acute Malnutrition
Severe Acute Malnutrition
6 – 59
Boys
n= %=
69 16.5
Girls
n= %=
66 19.2
Total
n= %=
135 17.7
6 – 35
51
18.3
50
22.7
101
20.2
5
36 – 59
18
12.8
17
13.3
35
13
1
Table 6:
Age group
(months)
Boys
n= %=
6
1.4
Girls
n=
%=
15
4.4
Total
n= %=
21
2.8
1.8
12
5.6
17
3.4
0.7
3
2.3
4
1.5
Global Acute Malnutrition
Boys
Girls
Total
6 – 59
n=
75
%=
17.9
n=
81
%=
23.6
n=
156
%=
20.5
6 – 35
56
20.1
62
28.3
118
23.6
36 – 59
19
13.5
20
15.6
39
14.5
The results were also analysed to determine possible differences between the prevalence of
moderate acute malnutrition in children, sampled by the survey, living in the urban and rural
7
14
OR = Odds Ratio, with in [ ] the corresponding 95% confidence interval.
areas. Results as summarised in table 7 indicate that the prevalence of acute malnutrition in
urban areas was significantly lower than in rural areas (OR = 0.58; [0.33 – 1.01]). Again, the
prevalence of acute malnutrition in children aged less than 3 years tended to be commoner
than in older children. This was however only significantly the case among urban children
(OR = 4.64; [1.05 – 42.65]. If stratified for urban and rural, differences in the prevalence of
malnutrition between boys and girls were no longer significant.
Table7:
Age
group
(months)
Rural Areas
Urban Areas
6 - 59
Prevalence of Moderate Acute
Prevalence of Moderate Acute
Malnutrition
Malnutrition
Boys
Girls
Total
Boys
Girls
Total
N=
%= n=
%= n=
%= n=
%= N=
%= n=
%=
53
17.4 51
21.5 104 19.3 16
13.4 15
14.7 31
13.9
6 - 35
39
19.5
36
22.1
75
21.1
12
14.5
14
36 - 59
14
13
20
18.9
34
15.7
5
11.4
0
23.8
0
26
5
18.5
5.4
C) Supporting Data
1. Prevalence of Diarrhoea and Respiratory Infections
The questionnaire sought information on whether the sampled child had suffered from
diarrhoea and respiratory infections in the two weeks prior the survey. This was considered
to be relevant information for this survey, as both conditions are known to have a negative
influence on nutritional status. It was found that 24.7% of the sample had suffered from
diarrhoea during this interval (24.1% for boys and 25.4% for girls). Children under three
years were significantly (over two times) more likely, to have experienced this condition than
older children (OR = 2.41; [1.61 – 3.57]). The incidence of respiratory infections among the
sample in the two weeks prior to the survey was 35.4% (35.9% for boys and 34.6% for girls).
Again, the incidence among children younger than three years was significantly higher (OR =
1.38; [0.99 – 1.93]).
A strong correlation was found between the prevalence of diarrhoea and respiratory
infections. Children who were reported to have suffered from diarrhoea in the two weeks
prior to the survey were seven times more likely to have also had a respiratory infection. The
odds ratio for this correlation was 7.01 with a 95% confidence interval of 4.81 to 10.23 (i.e.
significant at the 95% level of significance). The correlation was similar among children
under and children above three years of age.
Linked to diarrhoea and respiratory infections, questions were also asked about a household’s
source of water. Table 8 displays the main source of water of the sampled households.
Table 8:
Main source of water
Frequency
Per cent
Tap in accommodation
244
30.6
Tap/tube well outside accommodation
383
48.1
Pond/Reservoir
45
5.6
Temporary water tanks
125
15.7
797
100
TOTAL
15
Although only a small percentage of respondents reported to obtain household water from a
pond/reservoir, it was found that children living in these households were over two times
more likely to suffer from diarrhoea and/or a respiratory infection. This correlation was
significant at the 95% level of significance (OR = 2.13; [1.09 – 4.15]). For the correlation
between water from a pond/reservoir and respiratory infections, the odds ratio was 2.19;
[1.14 - 4.21].
As a crude determination of hygiene, each respondent was questioned on how often his or her
child was bathed. The majority (87.7%) of children were reported to be bathed at least once a
day (refer to Table 9). As might be expected, a correlation was found between the frequency
of bathing a child and the prevalence of diarrhoea and respiratory infection. Children who
were bathed once a week or less, were almost four times more likely to suffer from diarrhoea
compared to children who were bathed more frequently (OR = 3.85; [1.94 - 7.66]). With
respect to respiratory infections, children who were bathed once a week or less were over 2
times more likely to have experienced a respiratory infection in the two weeks prior to the
survey (OR = 2.21; [1.12 - 4.38]).
Table 9:
How often bath child
More than once/day
Once/day
2 to 3 time/week
Once/week
Less than once/week
TOTAL
Frequency
83
615
57
16
25
796
Per cent
10.4
77.3
7.2
2
3.1
100
This study found a significant correlation between acute malnutrition and diarrhoea reported
in the two week interval prior to the survey (OR = 1.64; [1.01 – 2.64]). Further analysis
revealed that this correlation can be attributed to the fact that the age group with the highest
prevalence of acute malnutrition, i.e. children less than 36 months of age, was found to be
twice as likely to be suffering from diarrhoea than their older counterparts (OR = 2.41; [1.61
- 3.57]).
When analysing the relationship between the reporting of a respiratory infection and acute
malnutrition in the entire sample of this survey, no association was found (OR = 1.09; [0.73 1.64]). When this relationship was explored for different age-groups, it was found that
children over 36 months with respiratory infections were almost four times more likely to be
suffering from acute malnutrition than their younger counterparts (OR = 3.88; [1.23 13.58]).
2. Displacement from home following the earthquake of January 26th 2001:
55.7% of the sample reported to have left their homes following the earthquake (61.2% from
urban areas and 53.5% from rural). Table 10 displays where these households are living now.
16
Table 10:
Staying now
Own Home
Camp
With relatives/friends
Open air
Other
Frequency
49
230
13
107
15
Per cent
11.8
55.6
3.1
25.8
3.6
Although a proportion (11.8%) of the displaced households has since returned home, many
are living in a camp or in the open air. The relationship between being displaced from a
home and currently living in a camp or the open air and malnutrition was explored. No
significant relationship was found (OR = 0.72; [0.4 -1.31]).
3. Food intake since the earthquake
The questionnaire sought to determine whether the food intake of the sampled children had
decreased, remained the same or had increased (maybe due to food aid/relief) since the
earthquake, that hit the district on the 26 January 2001. Table 11 displays the results
obtained:
Table 11:
Compared to before the
earthquake, food intake of child
(between 6 to 59 months)
Increased
Remained the same
Decreased
Total
Boys
n
12
319
100
431
%
2.8
74
23.2
100
Girls
n
15
289
56
360
%
4.2
80.3
15.6
100
Total
n
27
608
156
791
%
3.4
76.9
19.7
100
Interestingly, particularly considering the high proportion of acute malnutrition found by this
survey, the majority of the respondents reported that the food intake of the sampled children
had remained the same. Also, despite a higher prevalence of acute malnutrition among the
female children included in this survey, a higher percentage of respondents reported that the
food intake of their male children had decreased since the earthquake (23.2% for boys as
opposed to15.6% for girls, OR = 1.63; [1.11 –2.38]).
Considering that children under 36 months were found by this survey to be more frequently
acutely malnourished, the above results were also analysed, focusing only on children under
36 months. No significant differences were found in the changes in food intake of this
group, as compared to the sample as a whole.
Among children above three year, food intake of boys were significantly more likely to have
decreased however (OR = 2.48; [1.22 - 5.10]).
Those children whose food intake was reported to have decreased since the earthquake were
found to be no more likely to be malnourished compared to those children whose food intake
had either remained the same or increased since the earthquake (OR = 0.94; [0.57 - 1.54]).
4. Breastfeeding of children aged 6 to 12 months
The correlation between breast feeding only and malnutrition was explored. Sixteen per cent
of the sample consisted of children aged between 6 to 12 months. Of these children, 40.7%
17
were being breasted only (i.e. had not been weaned), despite the recommendation to
introduce weaning foods at the age of six months. No significant relationship was found
between delayed weaning and malnutrition (OR = 0.82; [0.28 - 2.33]). 8.1% of the infants
under one year were no longer receiving breast milk and had been completely weaned onto
solid food, although it is recommended that breast-feeding continues for at least the first year
of life. No correlation was found between not receiving breast milk (i.e. fully weaned) and
malnutrition for children aged between 6 to 12 months (OR = 3.96; [0.79 - 19.55]).
5. Registration with an Anganwadi Centre
The Department of Women and Child Development, Government of India, through its
Integrated Child Development Services programme, reaches out to about 30 million children
below six years of age, pregnant and lactating women and mothers, belonging to
disadvantaged and vulnerable communities, through a network of 500,000 Anganwadi
Centres throughout India. Each Anganwadi Centre (AWC) provides the following services:
1. Supplementary food, providing 300 Kcals and 10g of protein, to children aged under 6
years and twice this amount to pregnant and lactating mothers, and also to severely
malnourished children for 300 days in a year.
2. Pre-school education to children aged 3 to 5 years.
3. Immunisation
4. Health check-up
5. 5. Referral services.
6. Nutrition and Health Education to women aged between 15 to 45 years.
Unfortunately since the earthquake, the activities of many of these centres have been
curtailed or halted. This survey collected information related to the registration of each
sampled child with an Anganwadi Centre and if registered their receipt of food from this
source. Approximately one third (33.9%) of the sampled children was reportedly registered
with an Anganwadi Centre. No gender differences were found in the level of registration
with these centres (33.6% for boys and 34.3% for girls). When analysed with respect to
urban and rural areas, a statistically significant difference was found between the registration
of children with an Anganwadi Centre depending on whether they live in an urban or rural
area. Only 6.6% of sampled children living in urban areas were reported to be registered with
an Anganwadi Centre, as opposed to 44.9% of their rural counterparts (OR =11.5; [6.44 20.87]). Also, significantly fewer children under three then above three were registered at an
Anganwadi Centre. Children aged three-year or older were one and a half time as likely to be
registered (OR 1.52; [1.11-2.10]). Children who were not registered at an Anganwadi
Centre, were significantly more likely to be malnourished than those registered (OR = 1.80:
[1.08 – 3.03]).
Of those children registered with an Anganwadi Centre, 58.2% were reported to receive
supplementary food (equivalent to 152 children out of the total sample of 798, which in turn
is equivalent to 19% of the total sample). No gender differences were found as 57.9% of
boys and 58.5% of girls registered with an Anganwadi Centre were reported to be receiving
food from this source. Although urban/rural differences exist in the proportion of children
18
registered with an Anganwadi Centre, no real differences were found in the proportion of
urban and rural registered children receiving food from an Anganwadi Centre i.e. 58.1% and
60% respectively. Biscuits were reported to be the predominant (95.6%) food item received
by the sampled children registered with an Anganwadi Centre. Table 12 illustrates that 84%
of the children obtaining supplementary food from an Anganwadi Centre received it at a
frequency of 6 days each week.
Table 12:
Frequency of
receiving food from
an Anganwadi Centre
Sex of Child
Boys
6 days
3 to 5 days/week
1 to 2 days/week
Other
Total
n=
73
0
11
0
84
Girls
%=
86.9
0
13.1
0
100
n=
55
3
9
2
69
%=
79.7
4.3
13
2.8
100
Total
n=
128
3
20
1
153
%=
83.7
2
13.1
0.7
100
No statistically significant relationship was found between the prevalence of acute
malnutrition and receiving food from an Anganwadi Centre (OR = 1.3; [0.85 - 2.00]). Nor
was the reporting of diarrhoea and a respiratory infection, in the two weeks prior to the
survey, found to be different in children receiving food from an Anganwadi Centre compared
to children not receiving food from this source.
Children who were reported to have diarrhoea in the two weeks prior to the survey, were
found to be significantly more likely to be registered with an Anganwadi Centre (OR = 2.27;
[1.52 - 3.33]) for diarrhoea. A similar correlation was found between having suffered from
respiratory infection and being registered (OR = 1.64; [1.16-2.27]). A likely explanation
for this is that the Anganwadi Centre is the first contact point for health services in the village
to which parents bring their child.
6. Receiving food from another agency (other than ICDS)
Approximately half of the sample (47.4%) reported to (also) receive food from an agency
other than ICDS (44.6% for boys and 50.8% for girls respectively). No urban/rural
differences were found in the receipt of food from other sources (i.e. 48% of respondents
from urban areas and 47.2% of respondents from rural areas reported to receive food from
other agencies). No relationship was found between receiving food from other agencies and
malnutrition (OR = 1.15; [0.78 - 1.70]).
From the children registered at an Anganwadi Centre, 49.2% received biscuits from another
agency. The proportion of children receiving biscuits was in particular high in Anjar, Rapar
and Bhachau taluka. In these talukas NGOs distributed WFP biscuits to children registered at
an AWC which due to damage or destruction for the time being is unable to provide normal
services. Taking into account this distribution, 81% of all children registered at an AWC
received supplementary feeding.
19
Discussion:
The prime focus of this survey was the determination of the level of acute malnutrition in the
District of Kachchh among children aged between 6 to 59 months as a proxy for the rest of
the population. The global level of acute malnutrition found by this survey was 20.5% (of
which 17.7% moderate acute malnutrition and 2.8% severe acute malnutrition).
Two other surveys, i.e. the National Family Health Survey (NFHS 2) and a survey on the
Nutrition Situation in Drought Affected Areas of Gujarat, were conducted before the
earthquake. These surveys also indicated that a large proportion of pre-school children living
in the State of Gujarat is wasted. The NFHS–2 survey was conducted by the Ministry of
Health and Family Welfare, in the period November 1998-March 1999, among a
representative sample of children aged 0-36 months of the whole of Gujarat. The NIN survey
was carried out by the National nutrition Institute (NIN), in May-June 2000, among children
aged 12 to 59 months in three of the nine districts worst affected by the drought. Table 12
summarises the results for acute malnutrition derived from each of these surveys.
Table 13:
Prevalence of Global Acute Malnutrition as determined by the following surveys:
NFHS-2 (1999)
(Age-group=0 to 36
months)
National Institute of
Nutrition (2000)
(Age-group=12 to 59 months)
WFP, IFRC, Oxfam and
Save the Children (2001)
(Age-group=6 to 59 months)
16.2 %
29.5 %
Global level =20.5 %
For <36 months = 23.6 %
Although in all the three assessments Z-scores were the method of statistical description and
comparison was made to the international reference values of NCHS/CDC, comparison
between the three is not straight forward, due to differences in sample frames and surveyed
population. However, taking into consideration that the survey carried out by the NFHS was
conducted before the drought, the NIN survey during a period in which effects of the second
year of drought were yet to come, and both before the earthquake, the prevalence of
malnutrition found in this survey is perhaps not as high as expected.
Considerable efforts by the government to mitigate the effects of the drought and earthquake
might well have contributed to the comparatively better nutritional situation of children
below 59 months. In the food sector the efforts in Kachchh include for instance a quick
revival of the Public Distribution System (PDS), temporarily extended eligibility and free
food distribution by the government and NGOs after the earthquake in the worst affected
areas. Findings of the WFP/UNICEF/ IFAD/CRS Food Insecurity and Vulnerability Profile
in Kachchh indicate that 45% of the food obtained by rural households after the earthquake
consisted of relief food provided by the government and/or NGOs.
Nevertheless, the level of wasting found in this survey is still very high and warrants
continual surveillance and a comprehensive food interventions that include general food
distribution and supplementary feeding, particularly as the activities of Anganwadi Centres
have been detrimentally affected since the earthquake.
This study found that acute malnutrition is more prevalent in the rural areas of the District of
Kachchh as compared to the urban areas. Because Katchchh’s rural economy is largely based
20
on agriculture, a likely explanation for this maybe the ongoing drought, which has far more
impact on households’ food security in rural than urban areas.
An interesting finding of this study was that more than 75% of the respondents reported that
food intake among children had remained the same since the earthquake. This is in line with
findings of the WFP/UNICEF/IFAD/CRS Food Insecurity and Vulnerability Profile, which
indicates that in particular women consume less during a crisis and children’s food intake is
the last to economise on. Information, gathered in this assessment, indicates that by and large
children’s energy intake has not decreased as a result of the earthquake. According to the
same assessment, in a drought year as well as after the earthquake, the food basket tends to
consist predominantly of cereals, lacking vegetables and pulses. Children’s milk intake
reportedly decreases to about half during crises. The drought, followed by the earthquake has
thus impacted primarily on the quality of the food intake, possibly resulting in nutrient
deficiencies. These in turn might be reflected in an increased level of stunting or a higher
prevalence of micro-nutrient deficiencies, not necessarily in a higher level of acute
malnutrition.
Not withstanding the above, nearly 20% of the respondents reported a decrease in food intake
of their children, significantly more by boys than by girls. The fact that children whose
intake had decreased were not more likely to be malnourished, in combination with
apparently contradicting effects on boys and girls, might indicate some ambiguity in the
perception of a decrease in intake. Whereas the survey attempted to link malnutrition to a
possible decrease in intake of food in terms of energy, respondents perception might not
necessarily be restricted to a decrease in the quantity but might well also consider a decrease
in the variety of foods consumed.
Many studies have highlighted the detrimental effect of diarrhoea and respiratory infections
on nutritional status on nutritional status. The incidence of these conditions tends to be
seasonal. In the District of Kachchh, diarrhoea tends to be more common during the dry
season, between February and June. Respiratory infections tend to increase from November
to January and reach a peak during February and June. About one quarter of the sampled
children were reported to have had diarrhoea in the two weeks prior to the survey (which was
conducted in March), and over one third had experienced a respiratory infection. The survey
found a correlation between having suffered from diarrhoea and malnutrition, but no relation
between respiratory infections in the two weeks prior to this assessment and malnutrition.
The correlation between diarrhoea and malnutrition could however be explained by a larger
incidence of diarrhoea among children under three, who were more likely to be malnourished
anyway. A possible explanation for this lack of a strong direct relation could relate to the
finding that children, with these conditions, were significantly more likely to be registered
with an Anganwadi Centre, where an Anganwadi worker would have been available to
provide health and nutrition advice besides supplementary food. This highlights the value of
Anganwadi centres and the need to support the resumption of their activities following their
disruption after the earthquake.
The link between hygiene and the incidence of diarrhoea and respiratory infections was
another finding of this survey. Although only a small proportion of the interviewed
households obtained their main source of water from a pond and bathed their children
infrequently, a strong positive relationship was found between these activities and reported
diarrhoea and respiratory infections. Therefore, health education/promotion on the
prevention of diseases of poor hygiene needs to be emphasised.
21
This survey found that only a third of the sample were registered with an Anganwadi Centre.
The Anganwadi Centres need to increase their out-reach activities –also in hamlets- to track
malnourished children, in particular girls under three, to be registered for supplementary
feeding in the centres regardless of fulfilling other criteria until such time an adequate
nutritional status is reached.
References:
1.
Ministry of Health and Family Welfare/International Institute for Population Sciences,
(1999): National Family Health Survey (NFHS-2) - Welfare of Children and Youth,
India, 1998-1999. International Institute for Population Sciences, India.
2.
National Institute of Nutrition, (2001): Diet and Nutrition Situation in Drought
Affected areas of Gujarat. National Institute of Nutrition, Indian Council of Medical
Research, Hyderabad, India.
3.
Medecins Sans Frontieres, (1995): Nutrition Guidelines 1st edition; Medecins Sans
Frontieres, Paris.
4.
World Food Programme, (2000): Food Insecurity Analysis of Gujarat, World Food
Programme, India.
5.
National Institute of Public Cupertino and Child Development, (1998): Statistics of
Children in India. Chandu Press, India.
6.
World Health Organization Working Group (1986): Use and Interpretation of
Anthropometric Indicators. Bulletin of the World Health Organization. 64: 929-949.
7.
Lancet Editorial. (1984): A measure of agreement on growth standards. Lancet, 1:
142-143.
8.
The Sphere Project. (2000): Humanitarian Charter and Minimum Standards in
Disaster Response. The Sphere Project, Geneva.
9.
Handbook of Statistics on Children, National Institute of Public Cooperation and
Child Development, New Delhi, 1998.
10.
Kachchh Navnirman Abhiyan, Gujarat Institute of Development Research, Tata
Institute of Social Sciences, Mumbai: Rapid Assessment of Earthquake Affected
Areas in Gujarat, February 2001.
22
ANNEX 1
CLUSTER SAMPLING FOR NUTRITION SURVEY, DISTRICT OF KUTCH
Taluka
Total
populati
on (1991
census)
Rapar
150,517
Estimated total
population
(projected by
18%)
177,610
Estim
ated 6
to 59
month
popula
tion
Cummul
-ative
population
Attributed
numbers
No of
cluster
s per
Taluk
a
26,642
26,642
1–
26,642
4
% of
population
living
in
urban
areas
11
Mandvi
146,834
173,264
25,990
52,632
26,643 52,632
3
Nakhatrana
116,944
137,994
20,699
73,331
52,623 73,331
Bhuj
277,215
327,114
49,067
122,398
Abdasa
86,402
101,954
15,293
Bhachau
114,759
135,416
Anjar
265,225
Lakhpat
% of
population
living in
rural
areas
No of
urban
clusters
per
Taluka
No of
rural
cluster
s per
Taluk
a
89
0
4
25
75
1
2
3
0
100
0
3
73,332 122,398
7
42
58
3
4
137,691
122,399 137,691
2
9
91
0
2
20,312
158,003
137,692 158,003
3
16
84
1
2
312,966
46,945
204,948
158,004 204,948
6
66
34
4
2
36,759
43,376
6,506
211,454
204,949 211,454
1
0
100
0
1
Mundra
68,682
81,045
12,157
223,611
211,455 223,611
1
17
83
0
1
TOTAL
1,263,337
1,490,739
223,611
------
------
30
------
------
9
21
1
ANNEX 2
CLUSTER SAMPLING FOR NUTRITION SURVEY, DISTRICT OF KUTCH
Selection of villages
Taluka
Rapar
Mandvi
Nakhatrana
Bhuj
Abdasa
Bhachau
Anjar
Lakhpat
Mundra
Rural
1. Lodrani*
2. Momaymora*
3. Hamiparmoti*
4. Trambau*
5. Vijapar
6. Badalpar
1. Maunani*
2. Potadiya*
3. Asambiya Nar
4. Chandgai
1. Dhoro *
2. Ugadi *
3. Madisar *
4. Vithon
5. Rampar (Roha)
1. Bhagadlo*
2. Raiyada*
3. Sadhara*
4. Kotay*
5. Paiya
6. Kuvathada
7. Nadara
1. Gudhar*
2. Vamoti Moti*
3. Nandhramota
1. Gadhada*
2. Baniam*
3. Vondhada
1. Amrapar*
2. Kotda*
3. Modsar
Data Collection Sites
Urban
1. Ward 1*
2. Ward 6
1. Ward 4*
2. Ward 8*
3. Ward 12*
4. Ward 16
5. Ward 20
1. Ward 2*
2. Ward 4
1. Ward 2*
2. Ward 3*
3. Ward 6*
4. Ward 9*
5. Ward 12
6. Ward 15
1. Karanpur*
2. Chamra
1. Depa*
2. Chhasja
* - data must be collected from all these sites. Data will be collected from the other sites ONLY if it is not
possible to collect the required sample size from the
sites marked with an asterix
1
ANNEX 3
TIME LINE FOR NUTRITION SURVEY IN DISTRICT OF KUTCH
Date
05.03.2001
06.03.2001
Day
Monday
Tuesday
07.03.2001
Wednesday
08.03.2001
Thursday
09.03.2001
Friday
10.03.2001
Saturday
11.03.2001
12.03.2001
Sunday
Monday
13.03.2001
Tuesday
14.03.2001
15.03.2001
16.03.2001
17.03.2001
18.03.2001
Wednesday
Thursday
Friday
Saturday
Sunday
19.03.2001
Monday
20.03.2001
21.03.2001
Tuesday
Wednesday
22.03.2001
23.03.2001
to26.03.2001
1
Thursday
Friday to
Monday
Action
Determine sampling methodology
Determine sampling methodology
Determine and prepare data collection
tools
Finalise sampling methodology
Prepare data collection tools
Determine and prepare logistical
arrangements
Finalise pre-pilot data collection tools
Translation of survey’s questionnaire
Prepare schedule and arrangements for
training of interviewers
Finalise and check on all logistical
arrangements
Prepare data input file - EPI-INFO
Training of interviewers
Training of interviewers and piloting of
data collection tools
Revision and finalisation of data
collection tools
Note: if this is not needed - start data
collection
Data Collection
Data Collection
Data Collection
Data Collection
Input of data into EPI-INFO/ EPI-NUT
software
Input of data into EPI-INFO/ EPI-NUT
software
Processing of data
Processing of data
Interpretation of data
Interpretation of data
Writing of survey report
ANNEX 4
NUTRITION SURVEY IN KUTCH DISTRICT, GUJARAT
QUESTIONNAIRE
A. General Information
1. Date of data collection
2. Location
3. House hold / Camp No
4. Name of the interviewer
5. Relationship of the respondent with the child
6. Religion
7. Caste
8. Name of the child
9. Sex of the child
Male / Female
10. Date / Month of birth and year
(Shown birth certificate / Informed with confidence / Estimated / Wild guess)
B. Anthropometric information about the child
1. Weight in kg:
2. Height / length in cm:
C. Information related to nutrition and health
1. Presence of nutritional oedema (interviewer to check)
Yes / No
2. In the past two weeks, has the child suffered from:
i
Diarrhoea (passing of 3 or more loose / watery stools per day) Yes / No
ii Cough / Cold / Fever / Pneumonia
1
Yes / No
3. What is the source of water?
i
Tap / Tube-well in the house
Yes (go to 3 ii)
No (go to 3 iii)
ii How many hours in a day do you get the water supply
2 hours or less / more than 2 hours
iii What is the source of water:
Source of water
Time taken to fetch water
Less than 30 30 – 60 minutes
More than 30 min
minute
Tap in the village
Tubewell
Pond / reservoire
Temporary water provided by
the government / NGO /
Others
4. How often do you bathe the child?
i more than once a day
ii once a day
iii 2-3 times a week
iv once week
v less than a week
5. On comparing with the pre-earthquake situation, has the food intake of the
child
i increased (due to food aid / relief)
ii decreased (due to injury / sickness / withdrawal of food aid)
iii remained same
6. If your child is between 6-59 months, are you breastfeeding the child regularly?
Yes / No
2
7. Are you giving the child any foods in addition to breast milk?
Yes / No
8. If yes, what is the type of food and what is the frequency of feeding?
Type of food
Less
than
once a
week
Once a
week
Frequency of feeding
2-3 times a Once a day
Twice a day
week
3 or more
times a
day
Gruel /
porridge
Rice / roti
Cooked
pulses
Mashed
vegetables /
friuts
Top milk
Any other
9. Due to / since earthquake, have any members of your family died?
Yes / No
10. If yes, what was the relationship of the dead person(s) with the child?
Name of
the dead
person(s)
Sibling
Father
Relationship with the child
Mother Grand
Grand
mother
father
Uncle
1
2
3
4
11. After earthquake, have you been displaced from your own home?
Yes / No
3
Aunt
12. If yes, where are you staying now and since when?
Place of stay
Duration
Since earthquake Last 4 weeks
Last 2 weeks
Own home
Camp
Relatives
Open air
Any other (please specify)
13. Was your child registered with the Anganwadi Centre (AWC) before the
earthquake?
Yes / No
14. If yes, is the child getting supplementary food from the AWC?
Yes / No
15. If yes, since when?
i last month
ii last 2 week
iii last week
16. Is the supplementary nutrition provided at the AWC on
i all the 6 days in a week
ii 3-5 days in a week
iii 1-2 days in a week
17. Is the family getting food from any other agency?
Yes / No
4