This document provides nutrition and health data for the district of Kalahandi in Odisha, India. It finds high rates of child stunting (44.6%), wasting (26.9%), and underweight (52.8%) in the district. Undernutrition is caused by inadequate food, health and care during the first two years of life. This is due to underlying issues like food insecurity, poor access to healthcare, and the low status of women. Basic causes include inequity, economic challenges, and lack of political will. The document recommends interventions that address the immediate, underlying and basic causes of undernutrition in a equitable manner.

1. 44,6
26,9
52,8
74,3
44,4
18,9
0,9
38,2
18,3
34,4
70,8
30,3
18,9
2,6
Children
stunted
(%)1,2,^
Children
wasted
(%)1,2,^
Children
underweight
(%)1,2,^
Children
with
any
anemia
(%)1,^^
Chronic
energy
deficiency
in
women
(%)1
Children
with
birthweight
<2500gms
(%)2,3
Adults
who
are
obese
in
the
district
(%)1
Kalahandi Odisha
^Children
aged
<5years;
^^Children
aged
0-­‐59
months
Source:
Data
source
provided
on
Page
4
49,9% 50,1%
7,7% 92,3%
18,2% 28,5% 53,3%
Kalahandi,
Odisha
DISTRICT
NUTRITION
PROFILE
Page
1
THE
STATE
OF
NUTRITION
IN
KALAHANDI
DISTRICT
DEMOGRAPHIC
PROFILE
Total
Population 15,76,869
MALE FEMALE
RURALURBAN
SC ST OTHERS
CHANGES
OVER
TIME
Odisha
(Children
aged
<5
years)
Kalahandi
(Children
aged
<5
years)
2005-­‐06
(NFHS-­‐3)
2013-­‐14
(RSOC)
2002-­‐04
(DLHS-­‐2)
2014
(CAB)
Stunting 42.4% 38.2% No
data
46.6%
Wasting 20.0% 18.3% No
data 26.9%
Underweight 39.5% 34.4% 40.2% 52.2%
CHILDREN
STUNTED1
CHILDREN
WASTED1
CHILDREN
UNDERWEIGHT1
44.6%
26.9%
52.8%
THE
PREVALENCE
OF
UNDERWEIGHT
HAS
INCREASED
IN
THE
DISTRICT
BETWEEN
2002
AND
2014
Kalahandiranks
548th
amongst
599
districts
in
India
(District
Development
Index)13

2. 94,0
100,0
81,6
98,0 97,6
78,4
Women
with
access
to
at
least
1
antenatal
care
coverage
(%)
Any
anemia
among
pregnant
women
(%)
Any
anemia
among
adolescent
girls
(%)
Kalahandi Odisha
86,5
40,7 42,1
65,1
11,9
84,4
80,378,7
30,7
55,5
25,8
68,8 68,6
14,0
87,2
58,3
Early
initiation
of
breastfeeding
(%)
Exclusive
breastfeeding
(%)
Children
(6-­‐8
mo)
who
received
any
solid/semi
solid
food
in
the
last
24
hours
(%)
Children
who
achieve
minimum
diet
diversity
(%)
Full
immunization
coverage
(%)
Children
(6-­‐35mo)
who
got
vitamin
A
supplementation
(%)
Children
suffering
from
diarrhoea
(%)
Children
<5
years
with
diarrhoea
treated
with
ORS
(%)
Women
aware
of
danger
signs
of
pneumonia
(%)
Page
2
Child undernutrition is caused by inadequacies in food, health and care for infants and young children, especially in
thefirst two years oflife (immediatecauses). Inadequate food, health and care arise from food insecurity, unsanitary
living conditions, low status ofwomen, and poor health care(underlying causes). These are, in turn, caused by social
inequity, economic challenges, poor political will and leadership to address these causes (basic causes). Interventions
to address undernutrition must address thesemultiplecauses ofundernutritionand do so in an equitablemanner.
IMMEDIATE
CAUSES
OF
UNDERNUTRITION
Areas
for
action:
Data
challenges:
IMMEDIATE
CAUSES
Breastfeeding,
nutrient
rich
foods,
and
eating
routine
Feeding
and
caregiving
practices,
parenting
stimulation
Low
burden
of
infectious
diseases
Optimum
fetal
and
child
nutrition
and
development
WHAT
FACTORS
CAUSE
UNDERNUTRITION? 4
UNDERLYING
CAUSES
Food
security:
availability,
economic
access
and
use
of
food
Feeding
and
caregiving
resources
(maternal,
household
and
community
level)
Access
to
and
use
of
health
services,
a
safe
and
hygienic
environment
BASIC
CAUSES
Knowledge
and
evidence
Politics
and
governance
Leadership,
capacity
and
financial
resources
Social,
economic,
political,
and
environmental
context
(national
and
global)
The
most
crucial
period
for
child
nutrition
is
from
pre-­‐pregnancy
to
the
second
year
of
life2
HOW
CAN
NUTRITION
IMPROVE?
ADOLESCENT
& MATERNAL
HEALTH1,3,5
DISEASE
BURDEN3
IMMUNIZATION
&
SUPPLEMENTATION3
INFANT
AND
YOUNG
CHILD
FEEDING2,3
0
10
20
30
40
50
60
70
80
90
100
Age
of
child
(in
months)
Percentage
of
child
stunting
(%)
Window
of
opportunity
Too
late
No
Data
No
Data
• Very
poor
rates
of
exclusive
breastfeeding,
which
need
urgent
attention
• No
district
level
data
available
on
children’s
diets
• Low
rates
of
immunization
and
vitamin
A
supplementation
• Alarming
levels
of
anaemia
among
pregnant
women
and
adolescent
girls
• Out-­‐dated
data;
poor
availability
of
data
on
key
immediate
determinants
of
under
nutrition
from
national
surveys
• Where
data
are
available,
indicator
definitions
are
non-­‐
standardized
and
often
differ
from
World
Health
Organisation
recommendations

3. 3,6
87,1
9,0
88,3
4,4
12,1 11,9
73,6
18,3
76,6
7,5
Girls
married
when
<18years
old
(%)
Ever
married
women/mothers
who
completed
primary
school
(%)
Women
who
completed
secondary
school
(%)
Women's
ownership
of
land
(%)
Access
to
improved
drinking
water
sources
(%)
Access
to
improved
sanitation
facilities
(%)
Open
defecation
(%)
Child
stool
disposal
in
a
sanitary
manner
(%)
Households
who
washed
hands
with
soap
before
a
meal
(%)^
50,9
41,7
74,4
53,5
95,3
25,3 27,7
63,7
50,8
70,6
52,4
94,6
66,9
45,0
Adult
literacy
rate
(%)7 Births
attended
by
skilled
health
personnel
(%)6
Household
has
access
to
Anganwadi
worker
(%)6
Household
has
access
to
a
Sub-­‐Health
Centre
(%)6
Household
has
access
to
primary/middle
school
(%)6
Households
who
demanded
and
received
work
through
NREGA
(%)10
Households
availing
banking
services
(%)7
Kalahandi Odisha
52,1
41,2
54,1
64,2
49,0 48,4
22,5
48,5
37,8
45,8
32,9
50,5
42,4 43,0
Household
share
of
expenditure
on
food
(%)
Household
share
of
food
expenditure
on
cereals
(%)
Households
in
the
district
involved
in
agriculture
(%)
Below
Poverty
Line
households
(%)
Households
ownership
of
agricultural
land
(%)
Households
living
in
a
permanent
house
(%)
Access
to
electricity
(%)
Kalahandi Odisha
SOCIO
ECONOMIC
CONDITIONS7,10,11
Page
3
UNDERLYING
CAUSES
OF
UNDERNUTRITION
BASIC
CAUSES
OF
UNDERNUTRITION
No
Data
No
Data
No
Data
No
Data
No
Data
WOMEN’S
STATUS3,6 WATER,
SANITATION
AND
HYGIENE7,8,9
FOOD
SECURITY10
No
Data
^Data
based
on
rural
population
only
Areas
for
immediate
action:
• Very
high
rates
of
open
defecation;
critical
need
to
increase
awareness
about
washing
hands
with
soap
and
ensuring
access
to
using
improved
sanitation
facilities
• Food
insecurity,
especially
diet
quality,
is
a
challenge
that
can
holdback
improvements
in
nutrition
• Very
few
households
live
in
a
permanent
house
and
have
access
to
electricity
Data
challenges:
• Difficult
to
compare
indicators
of
water,
sanitation
and
hygiene
over
time
as
census
data
do
not
provide
data
on
child
stool
disposal
or
on
hand
washing
• Per
capita
gross
district
domestic
product
of
Kalahandi ranked
19th
amongst
30
districts
of
Odisha12
• Access
to
skilled
health
personnel
during
child
delivery
is
very
limited
and
few
households
avail
banking
services
• Action
needs
to
be
taken
to
improve
adult
literacy
which
is
low
• No
data
available
on
indicators
of
governance
and
political
will
to
address
nutrition
No
Data

4. Data
sources
1. Census
of
India.
2014.
Clinical,
Anthropometric
&
Bio-­‐chemical
(CAB)
survey.
http://www.censusindia.gov.in/2011census/hh-­‐series/HH-­‐
2/Odisha%20CAB%20Sample%20Characteristics%202014.pdf
2. UNICEF.
2013-­‐2014.
Rapid
Survey
on
Children
(RSoC).
http://wcd.nic.in/RSOC/21.RSOC_Odisha.pdf
3. Census
of
India.
2012-­‐2013.
Annual
Health
Survey.
http://www.censusindia.gov.in/vital_statistics/AHSBulletins/AHS_Bulletin_2012_13/Odisha/Odisha.pdf
4. Robert
E
Black,
Cesar
G
Victora,
Susan
P
Walker,
Zulfiqar
A
Bhutta,
Parul Christian,
Mercedes
de
Onis,
Majid
Ezzati,
Sally
Grantham-­‐McGregor,
Joanne
Katz,
Reynaldo
Martorell,
Ricardo
Uauy,
and
the
Maternal
and
Child
Nutrition
Study
Group.
2013.
“Maternal
and
Child
Undernutrition
and
Overweight
in
Low-­‐Income
and
Middle-­‐
Income
Countries”. The
Lancet
382
(9890),
427-­‐451
5. District
Level
Household
Survey
on
Reproductive
and
Child
Health
(DLHS-­‐2),
2002-­‐04,
India.
International
Institute
for
Population
Studies.
(IIPS).
2006.
District
Level
Household
Survey
on
Reproductive
and
Child
Health
(DLHS-­‐2),
2002-­‐04,
India:
Nutritional
Status
of
Children
and
Prevalence
of
Anemia
among
Children,
Adolescent
Girls
and
Pregnant
Women.
Mumbai:
IIPS.
October
28,
2015,
www.rchiips.org/pdf/rch2/National_Nutrition_Report_RCH-­‐II.pdf
6. International
Institute
for
Population
Studies
(IIPS).
2010.
District
Level
Household
Survey
and
Facility
Survey
(DLHS-­‐3),
2007-­‐08,
India,
Odisha.
Mumbai:
IIPS.
Accessed
October
28,
2015,
www.rchiips.org/pdf/rch3/report/UP.pdf
7. Census
of
India.
2011.
Houselisting and
Housing
Census
Data. Accessed
October
28,
2015,
www.censusindia.gov.in/2011census/hlo/HLO_Tables.html
8. National
Family
Health
Survey
(NFHS-­‐3),
2005-­‐06,
India.
Mumbai:
International
Institute
for
Population
Studies.
9. HUNGaMA:
Fighting
Hunger
&
Malnutrition
:
the
HUNGaMA
Survey
Report.
2011.
Naandi Foundation.
10. Author’s
estimates
based
on
Household
Consumption
Expenditure,
National
Sample
Survey
Office
(NSSO)
68th
Round,
2011-­‐12.
Ministry
of
Statistics
and
Program
Implementation.
Government
of
India.
11. Planning
Commission.
2013.
Press
note
on
poverty
estimates,
2011-­‐12.
Government
of
India.
Accessed
October
28,
2015.
http://planningcommission.nic.in/news/pre_pov2307.pdf
12. Government
of
Odisha.
Economic
Survey
(2014-­‐15).
Accessed
October
28,
2015,
http://www.odisha.gov.in/pc/Download/Economic_Survey_2014-­‐15.pdf
13. Us-­‐India
Policy
Institute.
2015.
District
Development
and
Diversity
Index.
Accessed
October
28,
2015, http://www.usindiapolicy.org/updates/general-­‐news/225-­‐district-­‐
development-­‐and-­‐diversity-­‐index-­‐report
This
District
Nutrition
Profile
was
developed
by
XXXXXX
for
POSHAN.
This
version,
dated
XX-­‐XX-­‐XXXX
is
a
draft
intended
for
use
in
a
district-­‐level
workshop
in
XXXX,
and
will
be
revised
following
workshop
discussions.
WHAT
WILL
IT
TAKE
TO
IMPROVE
NUTRITION
IN
KALAHANDI?
Possible
district-­‐level
actions
to
support
nutrition:
Source:
POSHAN/IFPRI-­‐NDO