Geo-visualising Diet, Anthropometric and Clinical Indicators for Children in India

The nutritional status of children in India fares much worse in global comparisons. Using the disaggregated data from the fourth National Family Health Survey (NFHS 2015-16), we present a dashboard and atlas for 31 nutritional indicators that include diet, anthropometry, clinical and service utilization measures of child nutrition for the districts of India. The geo-visualisations are presented with a motivation to help various stakeholders prioritise indicators and districts for interventions. 

Notwithstanding the value of utilising the summary data for select indicators made available by the fifth NFHS (2019-20) for 17 states and 5 Union Territories, it is important to note that a truly all-India picture covering all districts of India will not be available at least until the later part of 2021. Even as we await the availability of disaggregated data for a full range of indicators, there remains much to be investigated and learned from a more detailed examination of the fourth round of the NFHS.

Related Publications

© Authors: Akhil Kumar, Weixing Zhang, S V Subramanian. Dashboard on Geo-visualising Diet, Anthropometric and Clinical Indicators for Children in India. December 2020, Cambridge MA, Harvard Center for Population and Development Studies.

NOTE: The legend and rank show the Prevalence-Headcount Metric (PHM) which was calculated by adding the normalized values of prevalence and headcount together. Blank areas with unavailable data.

28e244e4ecbda4173080551c2629bcfa

Citation: Subramanian S V, Sarwal R, Joe W, Kim R. Geo-visualising Diet, Anthropometric and Clinical Indicators for Children in India: Enabling District Prioritisation for Interventions. December, 2020. Cambridge, MA: Harvard Center for Population and Development Studies; New Delhi: Institute of Economic Growth. doi:10.7910/DVN/ZSH8HR

Methodology & Indicators

PHM Methodology

We estimated the burden for each of the nutritional deprivation indicators along two dimensions of Prevalence (P) and Headcount (H), and combined them to derive a Prevalence-Headcount Metric (PHM).

Prevalence

The metric P was calculated as children with nutritional deprivation (q) divided by the eligible sample of children (n) in the district (j) and expressed in percentage as:

Pj= (qj / nj) × 100

The P metric quantifies the risk of a child experiencing nutritional deprivation in a district. For example, in the Kupwara district of Jammu and Kashmir, 137 (q) out of 435 (n) sample of eligible children were stunted, translating into a district prevalence of 31.5%; in other words, one out of every three children is at risk of being stunted. Thus, the P metric helps identify districts where the future risk of a specific nutritional deprivation should be reduced.

However, the P metric does not contain any information on the absolute number of children who are at risk because it does not take into account the total population of children in a district. For example, consider the districts of Hyderabad (16.7%) and South Garo Hills (16.6%); both have the same P metric but differ with regards to the under-five population of 398,513 and 23,953, respectively, translating to different levels of absolute burden.

Headcount

The metric H is given as the product of P and the total eligible population N for each district.

Hj= Pj× Nj

Returning to the above example, the number (H) of stunted children is substantially large in Hyderabad (66,553) than South Garo Hills (3,970) despite both districts having the same prevalence because the total population burden by nutrition deprivation in Hyderabad is substantially larger.

Prevalence-Headcount Metric

We developed a combined Prevalence-Headcount metric (PHM) that takes into account the features of both the risk (P) as well as the headcount (H) to provide a comprehensive picture of the burden of nutritional deprivation in a district. We computed the PHM using the following steps. We exemplify these steps using the district of Kupwara, Jammu and Kashmir for the nutritional deprivation indicator of stunting.

Variable Descriptions
Calculation Process

Types of Nutritional Deficit

Indicator Age Group Definition
Diet and Anthroprometric Failure 6-23 months Children with both dietary as well as anthropometric failures
Diet Failure Only 6-23 months Children with at least one or more dietary failures but no anthropometric failure
Anthropometric Failure Only 6-23 months Children with at least one or more anthropometric failures but no dietary failure

Dietary Measures

Indicator Age Group Definition
Inadequate Diet 6-23 months Children who did not receive minimum acceptable diet
Inadequate Diet Diversity 6-23 months Children who did not receive minimum dietary diversity
No Solid/Semi-Solid Food 6-23 months Children who did not consume solid or semi solid food in the day or night preceding the interview
No Dairy 6-23 months Children who did not consume milk and milk products in the day or night preceding the interview
No Nuts/Legumes 6-23 months Children who did not consume nuts and legumes in the day or night preceding the interview
No Grains/Roots/Tubers 6-23 months Children who did not consume grains in the day or night preceding the interview
No Eggs 6-23 months Children who did not consume eggs in the day or night preceding the interview
No Flesh Foods 6-23 months Children who did not consume fish, chicken, meat in the day or night preceding the interview
No Vit-A Rich Fruits/Vegetables 6-23 months Children who did not consume Vit-A rich fruits and vegetables in the day or night preceding the interview
No Other Fruits/Vegetables 6-23 months Children who did not consume other fruits and Vegetables in the day or night preceding the interview

Anthropometric/Clinical Measures

Indicator Age Group Definition
Stunting or Underweight or Wasting 0-59 months Children who are either stunted, wasted or underweight
Stunting & Underweight & Wasting 0-59 months Children who are stunted, underweight and wasted
Stunting & Underweight 0-59 months Children who are stunted and underweight but not wasted
Underweight & Wasting 0-59 months Children who are underweight and wasted but not stunted
Stunting 0-59 months Children who are stunted (short height-to-age)
Severe Stunting 0-59 months Children who are severly stunted (short height-to-age)
Underweight 0-59 months Children who are underweight (low weight-to-age)
Severe Underweight 0-59 months Children who are severely underweight (low weight-to-age)
Wasting 0-59 months Children who are wasted (low weight-to-height)
Severe Wasting 0-59 months Children who are severely wasted (low weight-to-height)
Anemia 6-59 months Children with hemoglobin level less than 11.0 g/dL
Severe Anemia 6-59 months Children with hemoglobin level less than 7.0 g/dL
Low Birth Weight 0-59 months Children with written record of birthweight less than 2.5 kg

Breastfeeding Practices

Indicator Age Group Definition
No Early Breastfeeding 0-12 months Children who were not breastfed within 1 hour of birth
No Exclusive Breastfeeding 0-12 months Children who were not exclusively breastfed

Service Utilization

Indicator Age Group Definition
No Hot Cooked Meal > 36 months Children who did not receive supplemnetary nutrition under ICDS
No Take Home Ration 6-36 months Children who did not receive supplemnetary nutrition under ICDS
No Vit-A Supplementation 6-59 months Children who did not receive Vit-A dose in the six months preceding the survey