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NUTRITIONAL STATUS OF THE COMMUNITIES IN THE RURAL AREAS - Current Scenario
Dr.G.N.V.Brahmam Dy. Director (Sr. Gr.), HoD,
Division of Community Studies,
National Institute of Nutrition, (I.C.M.R.)
Jamai-Osmania (P.O.),
Hyderabad – 500 007.
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“Nutrition monitoring is the measurement of the changes over time in the nutritional status of a population or a specific group of
individuals” -- WHO, 1984Nutrition Monitoring is essential
- to assess the type, magnitude & distribution of
nutrition problems in the community,
- to evolve policies and to formulate & implement
programmes for the prevention and control of
malnutrition and
- to evaluate on-going nutrition programmes to
assess their impact and to initiate corrective
steps needed, if any.
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NUTRITIONAL SURVEILLANCE
“ TO WATCH OVER NUTRTION IN ORDER TO MAKE
DECISIONS WHICH WILL LEAD TO IMPROVEMENT
IN NUTRITION IN POPULATIONS”. NUTRITIONAL
SURVEILLANCE METHODS PROVIDE REGULAR
INFORMATION ABOUT NUTRITION IN POPULATION;
THEY DRAW DATA FROM MOST SUITABLE
SOURCES THAT ARE ALREADY AVAILBLE,
INCLUDING SURVEYS AND ADMINISTATIVE DATA.
THE UNDERTAKING OF ADHOC INVESTIGATIONS
CAN ALSO BE INCLUDED IN NUTRITIONAL
SURVEILLANCE. FAO/WHO/UNICEF EXPERT COMMITTEE (1976) AND ELABORATED UPON BY MASON et al, 1984
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HOUSEHOLD FOOD SECURITY:
Ability of the Household to access food which is culturally acceptable and adequate in terms of quality, quantity and safety for all members of the household throughout the year, in order to ensure active and healthy life
HOUSEHOLD FOOD INSECURITY:
Presently or potential inability to consume food which is adequate, having all the nutrients essential for a healthy and productive life.
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NNMB was established in the year 1972, under the aegis of ICMR in the States of :
ANDHRA PRADESH
KARNATAKA
KERALA
TAMIL NADU
MAHARASHTRA
MADHYA PRADESH
ORISSA
UTTAR PRADESH
GUJARAT AND
WEST BENGAL
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OBJECTIVES OF NNMB
To collect, on a continuous basis, on
representative segments of population in each of
the States, data on dietary pattern and nutritional
status by adopting standardized and uniform
procedures and techniques, and
To evaluate periodically, the ongoing national
nutrition programmes, to identify their strengths
and weaknesses and recommend appropriate
corrective measures.
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ICMR
NIN - CRL
STEERING COMMITTEE
10 State Units
ORGANIZATION CHART OF NNMB
STAFF / UNIT
Medical OfficerNutritionistSocial WorkerField AttendantDriver
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INVESTIGATIONS
Household demographic & socio-economic
particulars,
Dietary intakes of households / individuals,
Anthropometry viz., Heights, weights, MUAC &
Skinfold at Triceps,
Clinical examination for prevalence of signs of
nutritional deficiencies and
Village level information such as population,
agricultural production, nutritional & other
developmental programmes.
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SAMPLING DESIGN
VILLAGES:
Sub-sample of NSSO sample frame of Consumer Expenditure survey carried out once in five years – to get better spatial distribution.
HOUSEHOLDS
Cluster sampling method
INDIVIDUALS
All individuals from the selected HHs.
Sub-sample by systematic random sampling procedure
SAMPLE SIZE
• Computed to arrive at State level estimates
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HIGHLIGHTS OF NNMB SURVEYS
Coverage of rural, tribal & urban communities,
Repeat surveys in rural communities during 1975-
79, 88-90, and 96-97, covering same villages,
Repeat surveys among tribal communities during
1985-87 & 1998-99,
Study of physiologically vulnerable groups such
as adolescent girls, elderly etc.,
Assessment of MNDs such as IDA, VAD & IDD by
covering adequate sample sizes to arrive at State
level estimates, and
Evaluation National nutrition programmes
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NUTRITIONAL STATUS OF THE RURAL POPULATIONS
NNMB Tech. Rep. #24, 2006
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SOCIO ECONOMIC PROFILE OF HOUSEHOLDS (%)
21.9
11
3730.1
0
20
40
60
SC ST BC Others
COMMUNITY
22.3
61.9
15.8
0
20
40
60
Kutcha Semi-Pucca Pucca
TYPE OF HOUSE
49.1
31.7
8.8 10.4
0
20
40
60
No Land MarginalFarmers
SmallFarmers
LargeFarmers
LAND OWNERSHIP
15.3
28.223.6
32.9
0
20
40
60
Agri. Lab Other Lab Cultivators Others
OCCUPATION
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SOCIO ECONOMIC PROFILE OF HOUSEHOLDS (Contd..)
29.0
34.4
15.6
21.0
0.0
10.0
20.0
30.0
40.0
50.0
<300 300-600 600-900 >=900
PER CAPITA INCOME / MONTH (%)
48
34.5
15.4
2.1
0
10
20
30
40
50
60
Illiterate 1-8 std. 9-12 std. College
FEMALE LITERACY (%)
27.4
75.572.1
0
20
40
60
80
Sanitary Latrine SeparateKitchen
Electrification
BASIC AMENITIES (%)
24
3539.1
1.1 0.80
10
20
30
40
50
OpenWell
TubeWell
Tap Pond Stream
SOURCE OF DRINKING WATER (%)
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Average Daily Food Intake (% RDA) among 1-3 Year Children : By Gender
31
321918
26
31 232
21987
6917
1435
3680
74
0 50 100 150 200
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals BoysGirls
Percent RDA
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Average Daily Food Intake (% RDA) among 4-6 Year Children : By Gender
26
2630
3323
27166
181
87
8623
1954
5276
79
0 50 100 150 200
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals BoysGirls
Percent RDA
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Average intake of Food stuffs (as % of RDA) Among Adults (Sedentary): By Gender
5746
3560
5767
150138
95125
4518
8565
9995
0 20 40 60 80 100 120 140 160
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals MenWomen
Percent of RDA
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Median Intake of Nutrients (as % RDA) Among 1-3 year children : By gender
6058
3230
6156
4343
67
671414
3835
4040
5754 87
83
0 25 50 75 100 125
F.Folic Acid
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
ProteinBoysGirls
Percent of RDA
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Median Intake of Nutrients (as % RDA) Among 4-6 year children : By gender
6466
3637 65
683030
67
6716
173738
4952
5759 87
90
0 25 50 75 100 125
F.F.Acid
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
ProteinBoysGirls
Percent of RDA
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Median Intake of Nutrients (as % RDA) Among Adults (sedentary): By Gender
73
83 118
10155
50 122
10816
2038
5086
10597
889091
0 25 50 75 100 125
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein Men
Women
Percent of RDA
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Distribution (%) of Children according to Protein - Calorie Adequacy
24.4
23.8
30.1
68.1
64.8
47.3
7.5
11.4
22.5
0 20 40 60
P+ C+
P+ C-
P- C-
1-3 Yrs
4-6 Yrs
7-9 Yrs
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Distribution (%) of Adults according to Protein - Calorie Adequacy Status
80.0
67.9
11.8
22.4
7.2
9.4
1
0.3
0 20 40 60 80 100
P+ C+
P+ C-
P- C-
P- C+Men
Women
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Distribution (%) of Households according to Protein - Calorie Adequacy Status
29.6
43.8
26.4
0.2
0 20 40
P+ C+
P+ C-
P- C-
P- C+
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INTRAFAMILY DISTRIBUTION OF DIETARY ENERGY IN RURAL INDIA
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Distribution (%) of Households According to Dietary Energy Adequacy Status of Adults Vs Children
DIETARY ENERGY INTAKE AGE GROUP
ADULTMALE
ADULTFEMALE CHILD
PRE-SCHOOL
SCHOOLAGE ADOLES-CENT
B G B G B G
+ + + 22.1 23.0 26.7 29.3 36.3 50.6
+ + - 51.0 52.6 44.9 45.9 32.7 21.3
+ - + 0.5 0.5 0.7 0.5 1.2 1.6
+ - - 4.0 3.6 3.9 3.3 3.1 2.5
- + + 2.0 2.1 3.3 2.7 4.4 7.0
- + - 11.3 9.9 10.7 9.9 10.1 6.9
- - + 1.4 1.1 0.7 0.5 1.3 1.3
- - - 7.7 7.2 9.1 8.0 10.8 9.1
+ : Adequate - : Inadequate ; 2 : 308.6 , p<0.001
ENERGY INADEQUACY 74.0 73.3 68.6 67.1 56.7 39.8
Source: NNMB- 2006
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ANTHROPOMETRY
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Distribution (%) of Pre-school children according to Gomez Classification – By Age Group
14.811.3 13
43.644.9
44.2
36.940.1
38.2
5.33.7 4.6
0
20
40
60
Normal Mild Moderate Severe
1-33-5Pooled
Per
cen
t
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Distribution (%) of Pre-school children according to Gomez Classification - By Gender
13.3 12.8
43.9 44.5
38.2 38.2
4.6 4.5
0
20
40
Normal Mild Moderate Severe
BoysGirls
Per
cen
t
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Prevalence of Undernutrition among <5 years children according to Weight for Age
(IAP classification)
39.9
56.458.7
57.4
56.8
61.0
20
40
60
80
6 12 24 36 48 60
Age (Months)
Per
Cen
t
Faulty BF Faulty Complementary feeding
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Prevalence (%) of Undernutrition Among 1-5 yr Children According to SD Classification (<Median - 2SD)
: By Age Group
55 55 5551 52 52
1516 15
0
20
40
60
Underweight Stunting Wasting
1-3 yrs3-5 yrsPooled
Per
cen
t
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Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median - 2SD): By Gender
55 55
5053
1614
0
20
40
60
Underweight Stunting Wasting
BoysGirls
Per
cen
t
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Distribution (%) of Adults by BMI Grades
3336
59
53
811
0
20
40
60
CED Normal Over Weight
Men
Women
Per
cen
t
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57.1 52.0 53.1
0
20
40
60
SC BC Others
60.0 54.846
0
20
40
60
80
Kutcha SemiPucca
Pucca
59.855.8
47.3 46.5
0
20
40
60
80
<300 300-600 600-900 >=900
60.1
53.3
46.537.6
0
20
40
60
80
Illiterate 1-8 Std 9-12 Std College
PREVALENCE (%) OF UNDERWEIGHT (< Median - 2SD) BY SOCIO-ECONOMIC VARIABLES
BY COMMUNITY BY TYPE OF HOUSE)
BY MONTHLY PCI BY FEMALE LITERACY
P<0.001 P<0.001
P<0.001P<0.001
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55.048.0 49.9
0
20
40
60
SC BC Others
55.1 52.3
41.1
0
20
40
60
80
Kutcha SemiPucca
Pucca
56.952
46.839.7
0
20
40
60
80
<300 300-600 600-900 >=900
PREVALENCE (%) OF STUNTING (< Median - 2SD) BY SOCIO-ECONOMIC VARIABLES
BY COMMUNITY BY TYPE OF HOUSE)
BY MONTHLY PCI BY FEMALE LITERACY
P<0.001 P<0.001
P<0.001P<0.001
57.250.3
41.133.3
0
20
40
60
80
Illiterate 1-8 Std 9-12 Std College
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15.4 14.3 14
0
5
10
15
20
SC BC Others
16.414.9
12.4
0
5
10
15
20
Kutcha SemiPucca
Pucca
14.215.9 15.4
14.3
0
5
10
15
20
<300 300-600 600-900 >=900
PREVALENCE (%) OF WASTING (< Median - 2SD) BY SOCIO-ECONOMIC VARIABLES
BY COMMUNITY BY TYPE OF HOUSE)
BY MONTHLY PCI BY FEMALE LITERACY
NS
P<0.001NS 16.9
14.6
11.4
7.5
0
5
10
15
20
Illiterate 1-8 Std 9-12 Std College
NS
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MICRO-NUTRIENT DEFICIENCIESNNMB-MND SURVEYS (Tech. Report #
23)
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Pooled: 0.7
< 0.5 %
0.5 %
Kerala0
Tamil Nadu 0.5
Karnataka0.8
Andhra Pradesh 1.2
Maharashtra1.4
Madhya Pradesh1.2
Orissa0.3 West Bengal
0.6
Prevalence (%) of Bitot spots among1 - <5 year children
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1.1
1.4
0.50.4
0
0.5
1
1.5
2
ST SC OBC OC
1.0
0.4
0
0.5
1
1.5
2
Illiterate Literate
1.2
0.9
0.60.5 0.4 0.3
0
0.5
1
1.5
2
Agl. Labout OtherLabour
Cultivators Artisans Service Business
0.6
0.90.7
0
0.5
1
1.5
2
<=4 5-7 >=8
Pe
r c
en
tP
er
ce
nt
Pe
r c
en
t
Pe
r c
en
t
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Community
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Occupation
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Family Size
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Female Literacy Status
Ag. Labour
Other Labour
Cultivators Artisans Service Business
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Distribution (%) of 1- 5 Yr. Children with Blood Vit. A Levels of < 20 G/dL, Median Dietary Intake of Vit. A (as % RDA) and
Extent of Coverage for Suppl. of Massive Dose Vit. A – By State
STATESBlood
Vitamin A < 20 g/dL
Dietary Intake of Vitamin A < 50% of RDA
Receipt of Massive Dose Vitamin A
1 or 2
Doses
No. of Doses
One Two
Kerala 79.4 91.8 38.5 28.4 10.1
Tamil Nadu 48.8 81.9 50.6 20.2 30.4
Karnataka 52.1 90.4 56.6 42.1 14.5
AP 61.5 92.9 49.3 14.2 35.1
Maharashtra 54.7 88.8 52.1 29.4 22.7
MP 88.0 87.4 52.3 19.1 33.2
Orissa 57.7 77.5 80.0 38.8 41.2
West Bengal 61.2 80.6 50.6 46.8 3.8
Pooled 61.8 86.3 55.4 30.3 25.1
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32.5 31.4 30.325.7 22.3 24.8
45.2
23.7
47 47.2
24.7
43.3 41.9
45.8
41.7
20.5 20.7
45.5
31.4 30.5
8.42.8 0.63.04.11.81.12.1
1-5 yr B+G 12-14 YrGirls.
15-17 Yr.Girls
Preg. W Lact. W NPNL. W Men
Normal Mild Moderate Severe
10.20.03
11.20.03
11.00.03
9.90.03
10.60.03
Mean ±SE
Prevalence (%) of Anaemia by Age, Gender & Physiological Groups
> 6 months < 6 months
10.71.99
12.62.09
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Pooled: 3.9
< 5 %
> 5 %
Kerala0.6
Tamil Nadu 0
Karnataka1.9
Andhra Pradesh 3.8
Maharashtra12.2
Madhya Pradesh4.3
Orissa0.1
West Bengal
9.0
Prevalence (%) of IDD among 6 - <12 Year
Children
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54.649.9
29.7 29.425.6 24.4
23.3
10.1
31.3
0
10
20
30
40
50
60
70
80
WB KER AP MR TN KAR ORI MP POOLED
Per cent of Households consuming salt having Per cent of Households consuming salt having adequateadequate
Amount (>=15 ppm) of IodineAmount (>=15 ppm) of Iodine
* By spot test
Per
cen
t
STATES
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NUTRITIONAL STATUS - TIME TRENDS
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Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey
8278
8290
40
3823
20
7068
808586
98
102110
0 50 100 150
O.Veg.
GLV
Pulses
Cereals
1975-771988-901996-972005-06
Percent
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Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey (contd.)
4770
9777
706065
705557
6177
120
8882
112
0 50 100 150
Sug&J ag.
Fats&Oils
Milk&MP
Roots&Tub.
1975-771988-901996-972005-06
Percent
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Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey
53 8997
108
110130
141
15276
879497
8290
97
103
0 50 100 150
Iron
Calcium
Energy
Protein 1975-791988-901996-972005-06
Percent
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110100
9398
9279
8992
436464
57100
100108
12543
5047
41
0 50 100 150
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
1975-791988-901996-972005-06
Percent
Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey (Contd.)
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Distribution (%) of Households According Dietary Energy Adequacy Status of Adults & Pre-school Child
-- Time Trends
31 31
2325
43
52
19
70 8
0
20
40
60
All Adequate AdultAdequate,Pre.sch.chiInadequate
All Inadequate
1975-801996-972005-06
%
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Distribution (%) of Households According to Dietary Energy Adequacy Status of Adults Vs Children
DIETARY ENERGY INTAKE AGE GROUP
ADULTMALE
ADULTFEMALE CHILD
PRE-SCHOOL
SCHOOLAGE ADOLESCENT
75-79 2001 2006 2001 2006 2001 2006
+ + + 31.1 31.1 22.1 47.3 27.9 61.6 43.2
+ + - 21.4 42.9 51.8 27.4 45.4 13.2 27.0
+ - + 2.3 1.4 0.5 1.4 00.6 2.1 1.4
+ - - 6.5 4.2 3.8 2.2 3.6 1.4 2.8
- + + 3.8 2.9 2.0 4.7 3.0 7.3 5.7
- + - 8.4 9.3 10.6 8.8 10.3 6.2 8.6
- - + 3.4 1.0 1.3 1.2 0.6 2.2 1.3
- - - 19.1 7.2 7.5 7.0 8.6 6.0 10.0
+ : Adequate - : Inadequate ; 2 : 308.6 , p<0.001
ENERGY INADEQUACY 55.4 63.6 73.7 45.4 67.9 26.8 48.4
Source: NNMB- 2006
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Distribution (%) of Households with Protein Calorie adequacy
73
80
84
78
30
48
53
58
0 50 100
Protein
Calorie
1975-79
1988-90
1996-97
2005-06
Percent
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Distance Charts for Heights and Weights for Males and Females - Andhra Pradesh
Males
60
80
100
120
140
160
180
200
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 19972005-06NCHS Std.
Females
60
80
100
120
140
160
180
200
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 19972005-06NCHS Std.
Males
0
20
40
60
80
100
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 19972005-06NCHS Std.
Females
0
20
40
60
80
100
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 19972005-06NCHS Std.
Hei
gh
t (C
m)
Hei
gh
t (C
m)
Wei
gh
t (K
g)
Wei
gh
t (K
g)
Age (Yrs) Age (Yrs)
Age (Yrs) Age (Yrs)
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Distribution (%) of Pre-school children (1-5 Yrs) According to Gomez Classification
6
10 913
32
3841
4448 44
44
38
15
96
5
0
10
20
30
40
50
60
Normal Mild Moderate Severe
1975-791988-901996-972005-06
Per
cen
t
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Distribution (%) of Children by Undernutrition and Period of Survey
64
4955
67
60
52
21 23
15
0
20
40
60
80
Stunting Underweight Wasting
1990-91
2000-01
2005-06
Per
cen
t
UNDERNUTRITION (< Median - 2SD)
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Distribution (%) of Adult Males according to BMI Grades by Period of Survey
56
4946
33
42
4850
59
2 34
8
0
20
40
60
CED Normal Over Weight
1975-79
1988-901996-97
2005-06
Per
cen
t
BMI <18.5 BMI:18.5 – 25.0 BMI: >=25.0
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Distribution (%) of Adult Females according to BMI Grades by Period of Survey
52 4948
36
4547 46
53
3 46
11
0
20
40
60
CED Normal Over Weight
1975-79
1988-90
1996-97
2005-06
Per
cen
t
BMI <18.5 BMI:18.5 – 25.0 BMI: >=25.0
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Prevalence (%) of Nutritional deficiency signs among Preschool Children
0.10.1
0.61.3
0.60.7
0.7
1.8
0.8
2.1
5.7
5.7
0 1 2 3 4 5 6 7
Marasmus
Bitot Spots
Ang.Stomat.
1975-79
1988-90
1996-97
2005-06
Percent
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Dist-
ricts
NorthernNorth-
EasternEastern Central Southern
PREV. Current PREV. Current PREV. Current PREV. Current PREV. Current
1 41.6 10.4 65.8 5.4 35.2 22.9 44.0 3.4 54.0 12.4
2 41.2 9.6 40.2 4.6 33.2 23.1 36.6 14.5 64.4 11.5
3 27.4 8.5 26.5 8.4 64.3 40.1 40.9 14.5 28.0 9.3
4 44.7 17.2 68.6 4.8 20.9 21.9 35.0 8.2 32.9 9.5
5 45.7 14.4 68.6 5.2 37.8 26.7 55.6 10.2 32.1 7.7
6 30.0 6.9 50.2 8.6 37.8 23.7 41.8 16.2 41.1 7.2
7 52.3 20.6 25.9 5.0 21.6 21.8 22.0 9.2 21.0 12.8
8 24.5 19.3 25.9 6.5 30.3 39.6 13.7 9.9 44.4 11.2
Prevalence of Total Goitre (%) in Select Districts of Different Regions of the Country :[National IDD survey (40 districts) 2003
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