study of malnutrition among under-6 children of sheopur district...

Study of malnutrition among under-6

children of Sheopur district with special focus on Saharia tribe

Project Report

Atal Bihari Vajpayee Institute of Good Governance

& Policy Analysis

Project Report

Study of malnutrition among under-6 children

of Sheopur district

with special focus on Saharia tribe

Atal Bihari Vajpayee Institute of Good Governance

& Policy Analysis

http://www.aiggpa.mp.gov.in/images/files/pdf/reports/Study%20on%20Status,%20Process%20of%20Appointment%20and%20Performance%20of%20Class%203%20Ministerial%20Staff%20in%20GoMP.pdf#page=1







































Project Team

Under the Guidance of

Akhilesh Argal, Director, AIGGPA

Madan Mohan Upadhyay, Principal Advisor,

Centre for Social Sector Development, AIGGPA

Project Coordinator

Richa Sharma, Deputy Advisor, State Health Resource Centre (SHRC),

Centre for Social Sector Development, AIGGPA

Consulant

Anil Mishra

Research Associate

Manisha Chouhan

Index S.No Particulars Page No

Executive Summary 1

1 Introduction 4

1.1 Understanding Malnutrition 5

1.2 About Sheopur 7

1.3 Karahal Block 8

1.4 Introduction to Saharia tribe 8

2 Objectives and methodology 9

2.1 Objectives of the study 10

2.2 Key stakeholders involved 10

2.3 Interaction with Saharia community at

Institute

11

2.4 Methodology and sampling 12

2.5 Data collection 13

2.6 Limitations of the study 14

3 Data analysis 15

3.1 Socio-Economic Parameters 15

3.2 Hygiene related aspects 23

3.3 Food habits in the community 25

3.4 Family Planning related issues 28

3.5 Pregnancy and childcare related aspects 30

3.6 Action taken during common childhood

illnesses

35

3.7 Services of Anganwadi 39

3.8 Vaccination 41

3.9 Nutrition Rehabilitation Centre 43

3.10 Alcohol and consumption of tobacco 44

3.11 Observation during field visit 44

3.12 MNREGA in the district and Karahal 48

4 Findings against key objectives 50

5 Recommendations 57

References 68

Annexures 70

Abbreviations and Acronyms

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWC Anganwadi Centre

AWW Anganwadi Worker, Anganwari Karyakarta

BPL Below Poverty Line

CSR Corporate Social Responsibility

ICDS Integrated Child Development Services

IFA Iron Folic Acid

MUAC Mid Upper Arm Circumference

NFHS National Family Health Survey

NRC Nutrition Rehabilitation Centre

NRHM National Rural Health Mission

POSHAN PM’s Overarching Scheme for Holistic Nourishment

WASH Water, Sanitation and Hygiene

WCD

Women and Child Development

Study of malnutrition among under-6 children of Sheopur district with

special focus on Saharia tribe 2018

Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 1

Executive Summary

Childhood under nutrition is an important area of concern in India. Children with Severe

Acute Malnutrition (SAM) have nine times higher risk of dying than well-nourished

children.With appropriate nutritional and clinical management, many of such deaths can be

prevented.Malnutrition among children is actually a manifestation of many other socio-

economic and cultural factors. General poverty coupled with lack of assured employment

round the year is the major issue which needs to be looked into. Generally there is a tendency

among the planners and administrators to look into malnutrition as a health related issue and

accordingly the interventions also focus on it. The main livelihood and poverty gets missed

out. All this necessitate that the problem is dealt with in a more comprehensive and multi-

disciplinary approach.

Sheopur is a predominantly tribal district with the Saharia being the major tribe residing

mostly in Karahal block of the district. This study has been planned in order to understand the

causal factors of malnutition in the area and thereby devising a context specific strategy to

combat this problem. On account of various parameters of deprivation, Karahal block in

Sheopur district was chosen as focal area for the study.

In order to develop an understanding of the issues faced by the Saharia community,

men and women from the Saharia community in Sheopur district were invited to Bhopal and

discussion was held on various aspects like climate in the region, livelihood opportunities,

drinking water etc to get an overall view.After getting an understanding of the overall

situation a detailed questionnaire was developed .The sample comprised of 200 families of

Saharia community and 200 Non-Saharia .Four local female field investigators who were

residents of the Sheopur district were involved in collection of data by means of the

questionnaire.

It was found that overall the children from the Saharia community had almost twice

the incidence of malnutrition the Non-Saharia community.Illiteracy in the block is very high,

73 % of the Saharias and 65 % of the Non-Sahariia respondents were illiterate. 90% the

Saharia community respondents worked as labourers while it was 48% for Non- Saharia.




Migration is a very significant aspect of the community in the area. It has an impact on the

uptake of the health and other ICDS, nutrition, vaccination related facilities in the area. This

breaks the continuity of the service delivery. Migration also reflects on the lack of livelihood

related options available in the area. Overall 34% of the households migrated to neighbouring

places for work. However among the Saharia households approximately 56% migrated for

work while only 12% of those from Non-Saharia households migrated for work. Though

women were adviced to consume additional food during pregnancy, it was found that

additional food consumption was up to a maximum of 3-6 months.The most common

illnesses reported for diarrhoea,fever and common-cold.

Saharia is notified as the Primitive Tribe Group (PTG) in Madhya Pradesh.It is

strongly recommended that the government should have a higher allocation for PTG

predominant blocks. It is also proposed that the quota of MNREGA allocation for 100 days

may be increased to 150 -200 days in the year for the next 5 years in Sheopur district.The

possibility of introducing a crash program for the next 4-5 years needs to be explored in order

to address livelihood related problem and nutrition requirement in the region. Approximately

60 % of the area of Sheopur district is under forest cover. Collecting tendu patta is one of the

commonly used forest based source of livelihood for the people in this area. Forests also

provide a range of marketable products like Resins (gum), Bahera, Nagar motha, Edible

gond, Satawar, Mahua etc. Many of the locally collected medicinal herbs fetch a good price

in open markets but the tribal people end up selling these products to the intermediaries at

abysmally lower prices. The support for marketing and value addition by creating processing

facilities would enhance the income in the community.It is recommended that a special plan

is drawn by the MFP cooperative federation, which has the resources, to identify all

marketable Minor Forest Products and create Self Help Groups (SHGs) for them. Such SHGs

should be empowered to scientifically harvest, process and sell at competitive prices to the

larger markets outside Karahal.

With effect from December 2017 onwards the Government has initiated a cash

assistance scheme of Rs 1,000 per month to each of the families of special backward

scheduled tribes (STs) as part of its efforts to eliminate malnutrition among the communities.

The amount of Rs 1000 per month is being provided to special backward ST communities,

including Saharia, Baiga and Bharia, to address the problem of malnutrition among them. The

amount is being deposited in the bank account of the woman head of the family to be used for




buying nutritious food items. This initiative of the Government is likely benefit the

community in addressing the problem of malnutrition among Saharia and other tribes also.

The focus should be on expanding access to primary education in this region .There is a

need for expansion of health care services in the affected area including reproductive and

child care, pre and post-natal care, vaccination etc. Intensive health awareness in the target

group of expectant mothers / adolescents needs to be launched in the campaign mode through

women and child development department and health and family welfare department.

The district of Sheopur is identified under Phase –I of the Poshan Abhiyaan

programme. It is the flagship programme of the Ministry of Women and Child Development

(MWCD),which ensures convergence with various programmes.It lays emphasis on the first

1000 days of the child, which includes the nine months of pregnancy, six months of exclusive

breastfeeding and the period from 6 months to 2 years to ensure focused interventions on

addressing under nutrition.

It is recommended that increased allocation of PDS be given to families having

severely underweight children and for and SAM children discharged from Nutrition

Rehabilitation Centres. Intensive monitoring is required at all levels including District

Collector, CEO Zilla Panchayat, Saharia Vikas Pradhikaran, Chief Medical Officer, Block

Medical Officer, Staff at Nutrition Rehabilitation Centre, Community Health Centre, Primary

Health Centre, ANMs, ASHA Karyakarta, Anganwadi Karyakarta etc need work in co-

ordination towards the aim of reducing malnutrition in the area. This will ensure that the

problem of malnutrition is addressed properly in the region. Looking into the level of

illiteracy in the regio and to address the specifics needs of the tribal community in local

languages resource is available in the form of Vanya radio station to enhance community

participation. It focuses on programs centred on tribal lifestyle, culture, society, traditions,

folk resources etc. Radio station Vanya located in Sesaipura (Sheopur) provides a great

window of opportunity as it makes programmes in Saharia dialect which is easily understood

by the community. This communication medium may be used more agressively to

communicate information on other aspects including hygeine, health, livelihood etc to the

community.




Chapter 1

Introduction

Childhood under nutrition is an important public health and

development challenge in India and such children have significantly higher risk of mortality

besides increased risk of death and diseases, this also leads to growth retardation and

impaired psychosocial and cognitive development. Children with Severe Acute Malnutrition

(SAM) have nine times higher risk of dying than well-nourished children1. In India, the

prevalence of SAM among children remains high despite overall economic growth1.

The National Family Health Survey-4 for India revealed that 7.5 percent of all

children under-five years of age are severely wasted (weight-for-height) 2

. With appropriate

nutritional and clinical management, many of such deaths can be prevented. Strong evidence

exists on synergy between under nutrition and child mortality due to common childhood

illnesses including diarrhoea, acute respiratory infections, malaria and measles. From the

perspective of health sector, the most important intervention is promotion of appropriate

infant and young child feeding and nutrition practices and related maternal under nutrition.

Malnutrition among children is actually a manifestation of many other socio-economic and

cultural factors. General poverty coupled with lack of assured employment round the year is

the major issue which needs to be looked into.

Generally there is a tendency among the planners and administrators to look into

malnutrition as a health related issue and accordingly the interventions also focus on it. The

main livelihood and poverty gets missed out. All this necessitate that the problem is dealt

with a more comprehensive multi-disciplinary approach.

Globally approximately 52 million children under 5 years are wasted and 70 percent

of them are in Asia3. Worldwide approximately 5 million children die every year due to

causes linked directly or indirectly to undernutrition4. Household allocation of scarce family

resources too affects child health. Children born with low birth weight are more likely to be

exposed to the risk of experiencing malnutrition as they grow up, and are also likely to have

high mortality risk5.




1.1 Understanding malnutrition

Malnutrition is a general term. It most often refers to under nutrition resulting from

inadequate consumption, poor absorption or excessive loss of nutrients, but the term can also

encompass over-nutrition, resulting from excessive intake of specific nutrients. An individual

will experience malnutrition if the appropriate amount of, or quality of nutrients comprising

for a healthy diet are not consumed for an extended period of time.

Impact of under nutrition

Children suffering from under nutrition begin their lives with a significant disadvantage. As

mentioned above, child malnutrition significantly contributes to under-five mortality as

undernourished children have increased susceptibility to infections and hence frequent

episodes of illness and longer recovery period.

Without treatment, children who are affected by moderate or severe acute

malnutrition during the critical stage of life between conception and age 2, if not provided

with timely and quality care, will find it difficult to achieve their full potential. Scientific

evidence has shown that beyond the age of 2-3 years, many effects of chronic under nutrition

are irreversible. This means that to break the intergenerational transmission of poverty and

under nutrition, children at risk must be reached during their first two years of life1.

Anthropometry is a widely used, inexpensive and non-invasive measure of the general

nutritional status of an individual or a population group. The three commonly used

anthropometric indices are:

Weight-For-Age (WFA).

Length-For-Age or Height-For-Age (HFA).

Weight-For-length or Weight-For-Height (WFH).

Types of under nutrition

The above three indices are used to identify three nutrition conditions: underweight, stunting

and wasting, respectively. Each of the three nutrition indicators is expressed in standard

deviation units (Z-scores) from the median of the reference population based on which under

nutrition may be further classified as moderate or severe.

Underweight: Underweight, based on weight for-age, is a composite measure of stunting

and wasting and is recommended as the indicator to assess changes in the magnitude of




malnutrition over time.

Stunting: Failure to achieve expected height/length as compared to healthy, well-nourished

children of the same age is a sign of stunting. Stunting is an indicator of linear growth

retardation that results from failure to receive adequate nutrition over a long period or

recurrent infections. This in turn affects economic productivity at national level. A stunted

child has a height-for-age Z-score that is at least two standard deviations (-2SD) below the

median for the WHO Child Growth Standards.

Wasting: Wasting represents a recent failure to receive adequate nutrition and may be

affected by recent episodes of diarrhoea and other acute illnesses. Wasting indicates current

or acute malnutrition resulting from failure to gain weight or actual weight loss. Causes

include inadequate food intake, incorrect feeding practices, disease, and infection or, more

frequently, a combination of these factors. Wasting in individual children and population

groups can change rapidly and shows marked seasonal patterns associated with changes in

food availability or disease prevalence to which it is very sensitive. A wasted child has a

weight-for-height Z-score that is at least two standard deviations (-2SD) below the median

for the WHO Child Growth Standards.

Severe Acute Malnutrition (SAM): Severe acute malnutrition is defined by very low

weight-for-height/length (Z- score below -3SD of the median WHO child growth standards),

a mid-upper arm circumference <115 mm, or by the presence of nutritional oedema.

Diagnostic criteria for SAM in children aged 6–60 months

Indicator Measure Cut-off

Severe

wasting

Weight-for-height < -3SD

Severe

wasting

MuAC (Mid Upper

Arm Circumference)

< 115mm

Bilateral

oedema

Clinical sign

-------

SAM increases significantly the risk of death in children under five years of age. It can be an

indirect cause of child death by increasing the case fatality rate in children suffering from

common illnesses such as diarrhoea and pneumonia. Children who are severely wasted are 9

times more likely to die than well-nourished children1.




Mechanism of measurement of under nutrition

According to the National Family Health Survey (NFHS-4, 2015-16) 55% of children in

Sheopur District under are of five years were underweight (low weight for age ) while the

same for Madhya Pradesh was 42.8% and 35.7 % at all India level. Further details on various

parameters under NFHS 4 are at Annexure 1. The problem of malnutrition is more acute in

the Sheopur district of Madhya Pradesh as compared to the National average and the overall

status of the same in Madhya Pradesh and thus is the focus area for the study.

1.2 About Sheopur

Sheopur is situated on the western part of the state. It is surrounded by Rajasthan’s Sawai-

Madhopur in the west, Kota in the south-west and Bara in the south whereas Shivpuri and

Morena in the east and the north respectively. It extends from 250 15’ to 250 45’ north

latitude and 760 22’ to 77022’ east longitude. Its geographical area is 6606 sq. km. The total

forest area of Sheopur is 3949 sq. km which is 59.79% to the total area (6606 sq. km) of the

district. Out of the 607 villages, only 180 villages are connected by road. The proportion of

Scheduled Tribes to the total population of Sheopur is 23.5% while the proportion of

Scheduled Caste population to the total population of Sheopur is 15.8 %. Majority of the

population of Sheopur (84.4%) lives in rural areas6.

Details about Sheopur district and its population etc are at Annexure 2.




1.3 Karahal Block

There are three blocks in Sheopur district namely: Vijaypur, Sheopur and Karahal. Karahal

block in Sheopur is the focus for the purpose of this study. This block has the highest

population of Scheduled Tribes (rural 63.08%) of the total population of the block.

21.53 % of population of Karahal block is cultivators while the percentage is (51.56

%) in Vijaypur block of the district. 62.63 % of the population in Karahal is engaged as

agricultural laborers6.Detail of block wise status (within Sheopur district ) on various

parameters as mentioned in district census handbook are available in Annexure 3.

1.4 The Saharia tribe

Madhya Pradesh is the tribal heartland of India. Among the 3 primitive tribal groups found

in Madhya Pradesh Saharia tribe is the largest one with 75.76 % of the total PTGs population

of Madhya Pradesh. (Source: Website of Tribal Welfare Dept. Govt of M.P.). The

sporadically concentration of Saharia are not only limited by political boundary in Madhya

Pradesh, but also their dispersals are located in Rajasthan, Andhra Pradesh, Orissa, Bihar and

rarely in West Bengal.

The early history of origination of Saharia is not exactly clear. Etymological point of view

expresses that the word ‘Sahria’ is the combination of two independent words like “Sa’

(companion) and ‘Haria’ (tiger) which mean companion of tiger. Most of the Saharia are

dependent on ecology which plays an important role in forming their economic structure

(Mandal, 1998)7. The past economic history implies that they traditionally practiced shifting

cultivation, hunting, gathering, pastoralism, etc. and sometimes also adopted nomadic life

(Prabhu, 1983)8 but in present time, most of the Saharias have become daily wage earner

instead of their traditional way of occupation (Singh, 1994)9. Most of them are landless and

poverty stricken. Roti is considered as their staple food. But sometimes, due to unavailability

of wheat, they consume roots, tubers, leaves, etc. too which are collected from the nearby

forests. They are very much addicted to drink local wine. Their area usually faces shortage of

water. Their poor food habits contribute to their malnutrition, especially among children and

pregnant mothers, which lead to increased susceptibility to morbid conditions10

.




Chapter 2

Objectives and Methodology

Sheopur is a predominantly tribal district with the Saharia being the major tribe residing

mostly in Karahal block of the district. Geographical isolation, unique cultural practices, low

female literacy, poor health seeking behaviour has subjected this population to a wide

spectrum of health problems in the form of both communicable and non communicable

diseases. Amongst these health problems, malnutrition in young children is the most pressing

one. The past few years have seen growing concern of government towards malnutrition in

general and tribal areas in particular. Certain deaths of children were reported to have

occurred due to malnutrition in the district. In order to understand the causal factors

and thereby devising a context specific strategy to combat this problem, a study was

assigned by the Health Department to this Institute on the issue of malnutrition among

under 6 children in the district with a special focus on Saharia tribe. On account of

various parameters of deprivation, Karahal block in Sheopur district was chosen as

focal area for the study.

In the past years several initiatives have been taken by the Central and the State Government

to curb malnutrition in general which include:

Integrated Child Development Services (ICDS) Scheme- key measures include regular

weight monitoring for early identification of growth faltering, nutritional supplementation in

the form of take home ration for under 6 children and lactating mothers, meal provision, iron

folic acid supplementation, Vitamin A supplementation, Nutrition counselling of mothers,

early referral to Nutrition Rehabilitation centre (NRC) if severe acute malnutrition or

medical complications arise.

Health Services- Antenatal, Intranatal and postnatal services, breastfeeding counselling and

support, immunization services, early detection and referral if required for common

childhood ailments including diarrhoea and acute respiratory infections.

Supplementation of Iron and Folic Acid to adolescent girls in schools to stall the

intergenerational cycle of malnutrition.

Mid Day Meal scheme for school going children.

Potable water supply




Assured Public distribution system.

Various other livelihood programs like MNREGA.

However, it is a long process with requirement of consistent efforts and there is always a

scope of learning and improving. This study aims to understand the determinants of

malnutrition in Saharia tribe of Sheopur.

2.1 Objectives of the study

1. To understand the underlying causes of malnutrition among the children in the study area.

It includes the following components.

a. To assess the socio cultural and economic status, means of livelihood, status of family and

food security situation in the study area.

b. To assess coverage of basic child health services like immunization, supplementary

nutrition, deworming, iron and folic acid supplementation, treatment of common ailments,

use of ORS and Zinc during diarrhoea, treatment of Acute Respiratory Infections etc in

children from Saharia and Non-Saharia families

c. To assess the knowledge, attitude and practice of the family regarding the infant, the young

child's nutrition and common childhood illnesses.

d. To assess the uptake of key maternal health services like Antenatal, intra-natal and

postnatal services and the ICDS centres in the study area.

2. To evaluate utilization of NRC services and relevance of its geo-physical location for

serving the high burden areas.

2.2 Key Stakeholders involved

Children from 0 to 6 yrs of age in Sheopur District

Families in the area having children of the age group 0-6 years

Health facilities in the district, including Nutrition Rehabilitation Centre

ICDS centres in the district

NRCs in the District

District Administration and associated departments

Rural Development Department, Govt of MP




2.3 Interaction with Individuals of Saharia community from Sheopur

district at AIGGPA

In order to develop an understanding of the issues faced by the Saharia community, men and

women from the Saharia community in Sheopur district were invited to the AIGGPA at

Bhopal. The discussion was held on various aspects like climate in the region, livelihood

opportunities, drinking water and nutrition and health related aspects to get an overall view of

the problem of malnutrition which is affecting the life of the children. This pre-study

discussion which was done in order to develop an understanding of the issues faced by them

which could help to plan the study in a better way.

The following issues emerged from this discussion:-

Livelihood related issues

Majority of them worked as labourers with land ownership in the range of 1 to 4 Bigah. The

main crops grown by them were Wheat, Mustard etc.

They usually work as agricultural labour during the sowing and harvesting season which is

for about 3 months in a year. Tendu Patta collection also provides them employment

through forest department which carries out the plucking operations and pays them wages

for that. They also collect various medicinal herbs that are sold in the local market.

Migration is common in the region – during lean seasons they move out to neighbouring

area in search of work as agricultural labourers.

Some families have domesticated animals like Cows or Hen (usually 2-5 per family). The

cows are not in good health and usually give milk only a few months of the year. They also

rear Hen in the household and sell their chicks in the market. During summers the eggs get

spoilt due to excess heat.

It is a rocky terrain with chronic scarcity of water and tap water is not readily available.

Hand pumps are the common source of drinking water which at times the water is not very

clean.

Nutrition and other aspects

Majority of the community are illiterates.

They suffer from various infections that result in diseases.




They get wheat from ration shop and some families grow vegetables. They also eat eggs at

times.

Child care related aspects

The average number of children per family in the community is 4 to 5.

108 ambulances services are available but the villages being in remote areas where road

access is not very good so they face problems during the rainy season.

At times, the marriage of girls in the Saharia community takes place before the age of 18

years.

2.4 Methodology and sampling

Karahal block having a population of 1,29,884 (as per 2011 census) was the focus of this

study. This block was selected as it is among the worst affected area in context to Severe

Acute Malnutrition (SAM).

When it is not possible to study an entire population but the population is known, a

smaller sample is taken using a purposive sampling technique. Slovin’s formula allows

researchers to sample the population with a desired degree of accuracy. This was used to

calculate the sample size. A confidence level of 95% was taken,

Slovin's formula is: n = N / (1 + Ne2)

Where: n = Number of samples, N = Total population e = Error tolerance

The Slovin’s formula was calculated as follows:

n = 129884/1+129884(0.05*0.05) =399

Using it, a sample of 400 children was taken from Karahal block. A child was eligible to be

enrolled in the study if he/she is more than one year and less than six years of age at the time

of collection of data. The study team did preferential selection of families having a SAM

child who was admitted in the health facility/NRC in the last three years to assess the patient

perspective of NRC functioning.




The study was designed as to enable the understanding of key factors that are specific

to the study population and may be playing a contributory or causal role in the childhood

malnutrition. The study intends to analyze the socio-cultural practices followed in the region

in Saharia families with those who are Non-Saharia. In order to do that the study was initiated

with a hypothetical consideration that there are probably, some factors; to which Saharia

families and children are getting exposed which is making Saharia children more vulnerable

to undernourishment. Keeping this hypothetical consideration in mind, a comparative element

was introduced in the study to help the project team draw comparison.

To eliminate bias in the village selection process, approach use was ‘Probability

Proportionate to Size’ (PPS) sampling. A 30-cluster approach for section of villages was

used. Within selected villages, to randomize household selection in a systematic manner,

segmentation of each village in 4 parts was done and two Saharia families and two Non-

Saharia families with children under more than one year of age but less than six years of age

were selected from each segment, with preferential selection of family having a severely

malnourished child (if not, then any malnourished child).

The sample taken for the purpose of the study comprises of 200 families from the

Saharia community and compares the same against 200 families of Non-Saharia families.

Efforts were done to include 100 families each of Saharia –malnourished, Saharia –normal,

Non –Saharia –malnourished and Non- Saharia –normal from the same area.

Village selection was done based on secondary data received from the office of

Collector, Sheopur. Primary data for socio-economic, cultural and food security aspects

besides data about Knowledge, attitudes and practices (KAP) was collected through specially

designed questionnaires. The KAP was administered to the mothers while general

information was collected from any adult member of the household, preferably the head of

the household. Details of village selection are available in Annexure 4.

2.5 Data Collection

For selection of households in the villages, the interviewers visited the Anganwadi and

identified the households which have children between 1 and 6 years of age. A household that

currently had a severely malnourished child in the stated age group in preceding 3 calendar

years was preferentially selected. The process of identification of household of household for

the purpose for the purpose of the study is given in Annexure 5.




Four local female field investigators who were residents of the Sheopur district

were identified for the purpose. The information was gathered about the youngest child in the

family in the age group 1 to 6 years called the index child for the purpose of the study. This

was done to be able to understand the child feeding practices, age at which complementary

feed was introduced to the child and certain other parameters like immunization etc. The

youngest child was chosen as the index child for the purpose of the study because the parents

are likely to recall information regarding care during pregnancy, immunization, services

taken from the Anganwadi etc easily for the youngest child.

During the collection of data from the village a total of 87 families of children

suffering with malnutrition could be identified from the Saharia community and 42 families

of children from the Non - Saharia community from the selected villages could be identified

and included in the survey. The survey was conducted on 200 Saharia and 200 Non-Saharia

families in the community.

2.6 Limitations of the study

The study is mainly based on primary data. There is a risk that because of the presence or

influence of the interviewer in a face-to-face interaction, the interviewer might unknowingly

bring out an untrue response to sensitive questions, e.g. the respondent may craft an answer to

please the interviewer instead of answering truthfully or the interviewer might record a verbal

response incorrectly because the statement is not interpreted correctly. Nevertheless, efforts

were made to minimize the possibility of error as the field investigators, for the purpose of

the study, were local from this area only.




Chapter 3

Data Analysis

Overall the children from the Saharia community had almost twice the incidence

of malnutrition than those who did not belong to the Saharia community. Thus the

findings on certain important parameters were analyzed at overall level of for the population

surveyed and also for the respective respondents of the Saharia and the Non-Saharia

community. The findings of the study are based on the responses received on various

parameters such as size of the family, number of children, livelihood related aspects, their

understanding related to health aspects etc. The findings are as under:

3.1 Socio- Economic Parameters:

Family type: Overall 84 % of the households covered under the study lived in a nuclear

family and the 16 % belonged to a joint family. Among the respondents Saharia households,

86 % of the Saharia households lived in a nuclear family while approximately 82 % of the

respondents from the Non-Saharia community lived in nuclear family.

Level of literacy in the household: The Saharia community has a higher percentage of

illiterate population than the Non-Saharia .Among the Saharia community, approximately 73

% of the respondents were illiterate while approximately 65 % of the Non – Saharia were

illiterate. Overall 69 % of the respondents were illiterate.

Graph 1: Level of literacy among the households

illiterate

69%

5th

10%

8th

10%

12th

9%

Graduate

1% Post

Graduate

1%




Graph 2: illiterates among Saharia and Non-Saharias

Opinion of the community on how many children a couple should have: 52 % of the

respondents were of the opinion that a couple should have three or more children.

Graph 3: Opinion of the community on the number of children a couple should have

Actual number of children in the family: Out of the households covered in the survey, 17

% had one child only, 31 % had two children overall 52 % of the households had 3 or more

showing the poor awareness about family planning in this region. When the same was

analyzed at the community level, 60 % of the Saharia households had 3 or more children

while 44 % of the Non-Saharia household surveyed had 3 or more children.

73 %

65 %

69 %

60

62

64

66

68

70

72

74

Saharia Non- saharia Overall

One

1%

Two

47% Three

40%

Four

11%

More than

four

1%




Graph 4: Actual number of children per couple at the community level

Graph 5: Saharia and Non-Saharia families having 3 or more children

Occupation: Approximately 69 % of the respondents worked as labourers , 21 % in

agriculture , almost 10% followed other occupation (collecting tendu patta ,selling milk,

teacher , petty employment , shopkeeper , selling Gums and Medicinal Herbs and taking care

of the cattle).When the same was analyzed among Saharia and Non-Saharias , huge majority

(90%) of the respondents from the Saharia community worked as labourers while only 48 %

among the Non- Saharia worked as labourers.

One

17%

Two

31% Three

27%

Four

16%

Five

5%

Six

3%

Seven

1%

60%

44%

52%

0

10

20

30

40

50

60

70





Graph 6: Occupation at the community level

Graph 7: Saharias and Non-Saharias working as labourers

Caste classification: 63 % of the respondents in the study belonged to the scheduled tribe, 27

% to other backward classes, 8 % to scheduled caste and only 2 % of belonged to the general

category.

Labourer

69%

Agriculture

21%

Other

10%

0

10

20

30

40

50

60

70

80

90


Saharia 90 %

Non- saharia

48 %

Overall 69 %




Graph 8: Caste category at the community level

Migration: Migration is a significant social aspect of the region and it has an impact on the



related options available in the area. Overall 34 % of the household mentioned that they

migrated to neighbouring places for work. However among the Saharia households

approximately 56 % migrated for work while only 12 % of those from Non-Saharia

households migrated for work.

Graph 8: Percentage of Saharias and Non –Saharias who migrated for work

Land Holding: Approximately 52% of the respondents had some land. Among Saharia only

for 39% of the respondents had land holding while among the Non-Saharia 65 % of the

respondents had land holding.

Scheduled

Caste

8%

Scheduled Tribe

63%

Other Backward

Classes

27%

General

2%

56%

12%

34%

0

10

20

30

40

50

60





Graph 9: Land holding among Saharia and Non-Saharia

Among those who had land, 75 % were marginal farmers, 19 % of them were small farmers

only 3 % were medium farmers while another 3 % were large farmers.

For the purpose of the study the following approximation was used:

Land holding less than 2.5 acre were considered marginal farmers, holding in the range 2.5

to 5 acre were considered small farmers and land in the range 5 acre to 10 acre were

considered medium farmers .Land holding greater than 10 acre were considered large

farmers.

Graph 10: Land holding at the community level

The major crops are grown during the Rabi and Kharif season. It was found that in some

cases they grow one crop on certain portion of land and another crop on the remaining

portion of land.

0

10

20

30

40

50

60

70

Saharia Non- saharia

Overall

39%

65%

52%

0 10 20 30 40 50 60 70 80

Marginal

farmers

Small

farmers

Medium

farmers

Large

farmers

75%

19 %

3% 3%




Kharif season: Urad dal, rice, bajara and soyabean were the commonly grown crop during

the kharif season.

Rabi crop: Wheat was the major crop during rabi season with 67 % of the land owners

growing wheat, 8 % grew chana, 1 % rice and 3 % mustard. There were some cases where

they did not grow any crop on the land during the Rabi season.

Domestic Animals: Almost 42 % of the respondents had domestic animals. In some cases

more than one animal was domesticated by them. Among animals, cow and buffalo were the

most common, followed by goat and hen.

Graph 11: Domestic Animals

However amongst those who had cow ,majority belonged to the Non-Saharia commuinty.

Only almost 10 % of the surveyed Saharia households had cow.

Annual family income: An effort was done to know the annual income of the household.

Huge majority around 91 % of the respondents mentioned their annual family income was

less than Rs 50,000

0

5

10

15

20

25

30

35

Cow Buffalo Goat Hen

34%

16%

5% 3%




Graph 12: Annual family income per annum in rupees

BPL card: Almost 65% of the respondents had BPL card. 77% of the respondents from the

Saharia community had BPL card while 52% of the respondents from the Non- Saharia

community had BPL card.

Graph 13: BPL card holders among Saharia and Non-Saharia

0

10

20

30

40

50

60

70

80

90

100

upto 50000 50001-1 lac > 1 lac >2 lacs

91%

7% 1% 1%

Saharia, 77 %

Non -Saharia,

52 %

Overall, 65 %

0

10

20

30

40

50

60

70

80

90

Saharia Non -Saharia Overall




3.2 Hygiene related aspects:

An effort was done to identify the commonly used source of drinking water in the community

and the practice followed, if any, for the treatment of water before using it for drinking. They

were asked about the practices they follow regarding washing their hands after defecation.

They were also asked about their practice regarding cutting nails, brushing the teeth and

frequency of brushing the teeth.

Source of drinking water: The respondents were asked about the source of drinking water

used by them. 48% of the mentioned that they used tube well water whereas 37% took water

from the hand pump, 6% used water from uncovered well, and 3% of the respondents used

water from covered well. Only 3% of the respondents have facility of piped drinking water.

Graph 14: Source of drinking water

About 10 % of the respondents mentioned that they found the water they used for drinking

was visibly dirty.

Treating drinking water before usage: 91 % of the respondents did not do anything extra to

purify the water. Only 4% added chlorine tablets to the water, 4 % cleaned the water with a

cloth, only 1 % of the respondents added alum powder (fitkari) to the water for cleaning the

same.

0

10

20

30

40

50

Open

well

Covered

well

Hand

Pump

Boring Water

from

pond

Piped

Water

6 % 3 %

37 %

48 %

2%

3%




Graph 15: Treating drinking water before usage

Washing hands after defecation: Attempt was made to know if the community is aware of

the importance of washing hands after defecation. 96% of the respondents mentioned that

they are aware of the importance of washing hands post defecation. However, when asked

about how they washed their hands post defecation, 46% of the respondents mentioned that

they washed hands with soap and water, while 34% used water and ash, approximately 10%

washed their hands with plain water and another 10% wash their hands with mud and water .

Graph 16: Practice of washing hands after defecation

Frequency of brushing of teeth: 96% of the respondents mentioned that they brush their

teeth only once a day (on waking up in the morning).

0 10 20 30 40 50 60 70 80 90

100

Filtering

the water

with cloth

Boiling Adding

fitkari

Adding

chlorine to

water

Nothing

4% 0 1% 4%

91%

0

10

20

30

40

50

With plain

water

With water

and soil

With ash

and water

Soap and

water

10% 10%

34%

46%




Graph 17: Frequency of brushing teeth

Practice regarding cleaning the teeth: 89% of the respondents used brush and toothpaste,

10 % of the respondents used twigs of neem tree (Azadirachta Indica) while 1 % of the

respondents cleaned their teeth with their fingers only.

Graph 18: Practice regarding cleaning of teeth

3.3 Food habits in the community:

Daily food habits: Almost all the respondents reported consumption of rotis on a daily basis,

while 72% of the respondents included dal in their daily diet. Only 30% of the respondents

consumed vegetables on a regular basis while 17 % of them consumed rice and 9% of the

respondents reported regular consumption of milk.

0

20

40

60

80

100

Once daily in

morning

Twice daily in

morning and

at night

Thrice daily One daily at

night

Once in a

while but not

daily

96 %

1% 0

3 %

0

0

10

20

30

40

50

60

70

80

90

With brush and

toothpaste

With neem twigs Cleaning of teeth

with fingers

89%

10 %

1%




Graph 19: Daily food items consumed at the community level

Food consumption pattern among the Saharia and Non –Saharia community: On

comparison it was found that only 24 % of the Saharia households consumed vegetables on a

regular basis while this percentage among the Non-Saharia was 37%. Only 11% of the

households of Saharia community consume rice on regular basis while this percentage among

the Non-Saharia was 23%. Approximately 35 % of the respondents mentioned that they

consumed milk at least sometime. The consumption of milk was also found to be much lower

among the Saharia families (11% in Saharia against 60 % in Non- Saharia).

Graph 20: Consumption of vegetables among Saharia and Non-Saharia

0

10

20

30

40

50

60

70

80

90

100

Rice Dal Roti Vegetables Milk

17%

72%

100%

30%

9%

24%

37%

30%

0

5

10

15

20

25

30

35

40


vegetables




Graph 21: Consumption of rice among Saharia and Non-Saharia

Graph 22: Milk consumed at least sometime among Saharia and Non-Saharia

Consumption of milk, egg and meat in the family: Milk is a good source of calcium while

eggs are a good source of protein. It is essential to identify the pattern of consumption of

milk, eggs and meat in the family to get a fair idea of the overall nutrition position in the

households. Consumption of milk was found to be very low among the Saharia community as

compared to their Non-Saharia counterparts. Only 6% of the respondents consumed eggs.

17% of the respondents consumed hen’s meat while 7% of the respondents consumed the

meat of goat.

Efforts were made to further analyze the daily food consumption patterns in terms of bowls

per day out of the respondents who reported consumption of rice, dal and vegetables. While

only about 30% of the respondents reporting consuming vegetables on a daily basis only 13%

of the same consumed 3-4 bowl of vegetable per day. The quantity of food intake also

depends on the size of the bowl. An effort was further done to analyze the size of the bowl of

11%

23%

17%

0

5

10

15

20

25


rice

11%

60%

35%

0

10

20

30

40

50

60

70

Saharia Non- saharia TOTAL




in which food was consumed on a regular basis 42% of the respondents used small size bowl,

41% of the respondents used a medium size bowl while only 17% of the respondents used

large size bowl on a regular basis.

Roti consumption pattern per day among the families was as under:

Average number of Rotis

eaten per person per day

Number of respondents Approximate Percentage

2-3 18 5 %

4-5 57 14%

6-7 64 16 %

8-9 147 37 %

10-12 114 28 %

Total 400 100 %

Recommended Dietary Allowance: It is essential to have a balanced diet for overall well

being of the individual. A balanced diet contains all essential (macro and micro) nutrients in

optimum quantities and in appropriate proportions that meet the requirements. The

recommended daily allowance of Balanced diet for Adults is available in the Dietary

Guidelines for Indians- A Manual published by National Institute of Nutrition, Indian

Council of Medical Research; Hyderabad (Enclosed as Annexure 6).It is evident from the

details of dietary pattern in the community that dietary needs of the community are not being

fulfilled.

Also given the fact that overall consumption of vegetables is low and the consumption of

milk, eggs and meat is meagre at the community level and and that tribal population is in

general prone to chronic energy deficiency they are more likely to suffer with Protein Energy

Malnutrition(PEM)11

.

3.4 Family planning related aspects:

Family planning: To know the level of awareness, the respondent women were asked about

the various methods of family planning. An unusual feature that was noticed here was the

usage of water extracted after boiling black pepper (kali mirch) or black cumin (jeera) for the

purpose of family planning. The respondents were also asked if they are using any method of

family planning. Almost 75% of the respondents mentioned that they are not using any




method of family planning. Among the respondent women who resorted to family planning

technique the commonly used techniques were operation and birth control pill. The usage of

family planning methods was found to be even lower among the Saharia community at

approximately 22%.

Graph 23: Any method of family planning used among Saharia and Non-Saharia

Age at the time of marriage and child birth related responses: The respondents were

asked about their opinion what should be the age of a girl at the time of marriage. 95 % of the

respondents felt the ideal age of marriage for girls should be 18 years or above while the

balance 5% felt that the girls should be married before the age of 18 years. Similar question

was asked about boy’s age. 90 % of the respondents felt the ideal age of marriage for boys

should be 21 years or above and only 10% felt that the boys should be married when they are

in the age group 18-21 years. Approximately 20 % of the respondent women mentioned that

they got married before attaining the age of 18 years.

Graph 24: Girl’s age at the time of marriage

22%

28%

25%

0

5

10

15

20

25

30


0

10

20

30

40

50

16 year 17 year 18 year 19- 21

years

Did not

respond

2%

18%

41%

13 %

26 %




Approximately 28 % of the respondent women from the Saharia community mentioned that

they were less than 18 years of age before marriage.

Graph 25: Age of the girl less than 18 years at time of marriage

3.5 Pregnancy and childcare related aspects:

Care during pregnancy: The respondents were asked whether they were aware of the need

for taking care during pregnancy. Further the respondents were asked about the care

/precautions actually taken by them during pregnancy. This was done in order to compare the

awareness with the practice actually followed.

Graph 26: Comparison of knowledge of precautions/care to be observed during

pregnancy and the care actually taken during pregnancy

28%

13%

20%

0

5

10

15

20

25

30


<18 years …

0 10 20 30 40 50 60 70 80 90

100 83

94 94 93 94

78

64 53

64

92 86 88 88

70

55

42

Knowledge of precautions/ care to be taken during pregnancy

Care /precautions actually taken during pregnancy




83% of respondents felt that they need to take adequate rest while only 64% of the

respondent’s actually took adequate rest during pregnancy. While only 53% of respondents

felt they should abstain from heavy work during pregnancy, actually only 42% of the women

refrained from doing heavy work during pregnancy.

The most commonly used service of the Anganwadi by the pregnant women and the lactating

mothers was the service of food. A question was asked to the respondents if they consumed

the take home ration themselves or shared the same with the family. 79% of the respondents

mentioned that they ate the take home ration themselves and gave it to their children. 8% of

the respondents shared the take home ration with the family and about 13% of the

respondents did not respond to this question. Respondents were asked if they had an abortion

during pregnancy, 3% of the respondents had an abortion during pregnancy.

Nutrition and care for the pregnant women and lactating mothers: It is essential that the

maternal nutrition should also be balanced, fresh and preferably home-made and there should

not be any unscientific restrictions. Optimal nutrition of adolescent girls, pre-pregnant

women and pregnant mothers is critical to growth, foetal well-being and to prevent

malnutrition in the postnatal period.

Information was gathered if there is a practice of giving additional nutrition for the pregnant

women and lactating mothers in the family. Only 68 % of the women actually followed the

advice of consuming additional / special diet during pregnancy or as lactating mothers.

Graph 27: Additional / Special diet taken by women during pregnancy / by lactating

mothers among the Saharia and Non-Saharia

65%

72%

68%

60

62

64

66

68

70

72





65 % of the mothers belonging to the Saharia community took some additional/special diet

during pregnancy or while they were breast feeding the baby. Among the women who

consumed certain additional eatables during pregnancy and while they were feeding the baby

with breast milk, 40% of the respondents consumed additional fruits, 34% took additional

vegetables, and 14 % took additional milk while 12% increased the quantity of the daily food.

However it was noticed that the additional food consumption was up to a maximum of

3-6 months only.

Graph 28: Additional eatables consumed by pregnant women / lactating mothers

Graph 29: Quantity and frequency of consumption of additional food by pregnant

women/ lactating mothers (value in percentage)

Fruits, 40%

Vegetables,

34%

Poshak Aahar,

12%

Milk, 14%

0

20

40

60

80

100

100-250

gm

250-500

gm

1-2 kg 1-2 time 3-4 time 1-2

months

3-6

months

Qty /day times/day for how many

months

48 40

12

66

34

89

11

28

69

3

27

73

13

87 81

19

0

100

0

34

66

82

10 8

100

0

18

82

Fruits 40% Vegetables 34% Poshak Aahar 12% Milk 14%




Infant feeding practices : Infant and young child feeding practices such as initiation of

breast feeding, feeding of colostrums, duration of exclusive breast feeding upto the child

reached the age of 6 months and particulars of complementary feeding in terms of age of

initiation, the type of complementary food and frequency of feeding was assessed. In

addition, information on socio-cultural aspects of infant and young child feeding practices by

mothers was also collected. For the well being of the child it is essential to feed the

colostrums. 92 % of the respondents said they fed the child with colostrums after birth while

8 % of the respondents started feeding the child after throwing the initial colostrum.

The respondents were asked if the children were given exclusive breast milk for the initial 6

months. 78% of the respondents gave exclusive breast milk to the babies while 21% of

the respondents gave water also in addition to mother’s milk. Only one percent of the

respondents gave other milk (mixed with water) in addition to mother’s milk.

Information was also gathered regarding the frequency of feeding the child to know if the

child gets sufficient nutrition. 47 % of the respondents fed the child whenever the child cried

for food, about 36 % of the respondents fed the child up to 4-5 times a day 7 % of the

respondents fed the child with breast milk 2-3 times while only 10 % of the respondents fed

the child every 2-3 hours during day and night also

Graph 30: Frequency of breastfeeding the index child

0

10

20

30

40

50

When ever

the child

cried for milk

2-3 times a

day

4-5 times a

day

Every 2-3

hours during

day / night

47%

7%

36%

10%




Initiation of semi-solid food: As the child grows it is essential to introduce semi-solid food

at the right age so that the growth of the child is not hampered. The general norm for the age

for introduction of semi-solid food for the child is around 6 months of age. Information was

gathered regarding their opinion on the right age of initiation of other semi-solid food

Graph 31: Opinion at community level on right age for introduction of complementary

feed

Majority of the respondents introduced complementary feed to the child when the child

was around 6-7 months of age.

Graph 32: Actual age of child when complementary feed was introduced

0

5

10

15

20

25

30

35

40

2-4

months

4-5

months

5-6

months

6-7

months

7-8

months

After 8

months

Age of the child in months

0 3 %

23%

40%

22%

12%

0

10

20

30

40

50

60

5 months 6 months 7 months 8 months

3%

51%

26%

20%




97 % of the respondents reported that they continued to give breast milk to the baby even

after the introduction of complementary feed. The respondents were further asked till what

age did they continued to give breast milk to the baby. 42% of the respondents continued to

feed the baby with breast milk up to the age of 2 years, while 34% continued till the child was

one and half years of age. 14% of the respondents continued to give breast milk up to the age

of one year, while 1% of the respondents continued doing so up to the age of eight months.

Graph 33: Age of the child till when feeding of breast milk was continued

According to the Infant and Young Child Feeding Guidelines, 2016 published by the Indian

Academy of Paediatrics, after the child reached six months of age introduction of optimal

complementary feeding should be practiced preferably with energy dense, home-made food.

Breastfeeding should be continued minimum for 2 years and beyond12

. However, in almost

49 % of the cases feeding of breast milk to the child was not continued till the child reached

two years of age. Thus it is essential to encourage the optimal feeding practices for the

children at the community level.

3.6 Action taken during childhood illnesses

One of the parameter for health and overall well being is absence of disease. An effort was

made to analyze the frequency of illness reported at the community level. The most

commonly reported illness were: fever, diarrhoea and common cold. The highest number of

0

5

10

15

20

25

30

35

40

45

continued

upto 8

months

continued

upto 1 year

continued

upto 1 and

half years

continued

upto2 to 3

years

continued

upto 3 to 4

years

1%

14%

34%

42%

10%




respondents (83%) mentioned that the child suffered from diarrhoea during the past one year,

this was followed by fever (79 %) and common cold (45%). Efforts were also made to view

further the frequency of occurrence of the illness. Majority of the children suffered with the

above mentioned illnesses on an average 2-5 times in a year.

The members from the Saharia community reported marginally higher incidence of illness as

compared to Non-Saharia, 86 % of the respondents of the Saharia community mentioned that

the children suffer from diarrhoea/ vomiting, while 42 % of respondents mentioned that their

children suffer with common cold while 76 % of the respondents from the Saharia

community that their children suffered with fever.

Graph 34: Common illness reported with annual frequency

An effort was further made to analyze the treatment/options exercised by respondents when

the children fell ill. Multiple responses were taken from the respondents as it is possible that

an individual may take more than one course of action during illness. 34% of the respondents

mentioned that they normally do not take much attention of common illness like fever,

diarrhoea and common cold the children get cured in some time. As high as 39% of the

respondents mentioned that they opted for jhad-phoonk practices while 21% of the

respondents used home remedies (gharelu nuska) for medication.

0

5

10

15

20

25

30

35

40

45

1-2 time 2-3 time 3-4 time 4-5 time 5-8 time

times / 1 year

13

32 31

17

7 5

44

32

16

3

12

27 26

18 17

Fever 79% Diarrhoea 83% Common cold 45%




Graph 35 : Action taken by the respondents during illness of the child

The children in the community frequently suffer with diarrhoea, information was collected on

what practices are followed in the community when the children suffer from diarrhoea.

Multiple responses were collected from the respondents. Approximately 84 % of the

respondents gave ORS to the children. The major source of getting ORS was ASHA/

Anganwadi karyakarta. Almost 57% of the respondents gave the children a solution of water

salt and sugar. Approximately 20% of the respondents used local herbs for the purpose of

treatment of diarrhoea.

0 10 20 30 40 50 60 70

Use home remedies

Jhad Phoonk

Show the child to ANM

Show the pateint to the only doctor available in

the village

ASHA/ ANM do not visit the village regularly so

have to take the patient out of village for …

Take the child to Sub -centre/ PHC/CHC

Take the child to district hospital

Take the child to private hospital

Do nothing

21

39

54

47

34

49%

56%

63%

34%




Graph 36: Action taken and feeding restrictions when child suffers with diarrhoea

Graph 37: Source from which ORS was obtained

0

10

20

30

40

50

60

70

80

90

8% 8% 8%

41% 42%

33% 30%

57%

20%

84%

0 10 20 30 40 50 60 70 80 90

70%

86%

65%

27%

31%




The respondents were also asked what action was taken when the child suffered with

respiratory or other illnesses. Multiple course of action is taken in such circumstances. The

responses were as under:

Graph 38: Action taken when child suffered with respiratory illness

Information was also gathered if they used any of the practices like witchcraft (jadu-tona) or

other course of action taken when the child fell ill, since multiple course of action can be

taken in such circumstance, multiple responses were taken from the respondents. 41% of the

respondents went for jhad-phoonk, 28 % of the respondents showed the child to any

baba/phakeer, 28 % took the child to any religious place while 17 % of the respondents used

the practices of witchcraft. The respondents from Saharia community marginally higher

inclination towards such practices.

3.7 Services of the Anganwadi

An effort was made to identify the awareness about the services of the Anganwadi centre.

The respondents showed a very high degree of awareness towards the services provided by

the Anganwadi. About 93 % of the respondents from Saharia community and 86 % of the

0 10 20 30 40 50 60 70

Did nothing

Took the child to ANM

Tried gharelu nuska, jadi-booti,kada etc

Consulted the ASHA

Took the child to Private doctor

Took the child to anganwadi

Adopted jhad-phoonk practices

Took the child to Govt hospital / centre

Took the child to private hospital

Used the medicine available at home which …

Admitted the child in a health facility

1%

61%

19%

66%

64%

56%

41%

50%

44%

12%

6%

Action taken when child suffered with respiratory

illness




respondents from the Non-Saharia community sent their children to Anganwadi centres. The

facility of nutritional food is one of the most significant facilities that is the first recall among

the services provided by the anganwadi. The Take home ration (THR) is one of the

mechanisms used in the anganwadi to ensure that nutritional food is available to the pregnant

and lactating women. An effort was done to identify if the take home ration was actually

consumed by the pregnant women and the children or did they share the same with the

family. 79 % of the respondents said they consumed the take home ration themselves and

shared the same with their children.

A feedback was taken from the respondents regarding the quality of service provided by the

anganwadi. The overall response was favourable.

Graph 39: Feedback on services of the Anganwadi

Measurement of weight of the child on regular basis: The weight of index child was taken

every month in 62 % of the cases while 26 % of the respondents mentioned that the growth of

weight of the index child was monitored 8-10 times in a year. Overall 88% of the respondents

mentioned that the weight of the child was regularly monitored by the Anganwadi.

0

10

20

30

40

50

60

6%

56%

34%

5% 0 0




Graph 40: Frequency of measurement of weight of the child by the Anganwadi in a year

An effort was done to identify the action taken when it is noticed that the child is not growing

well. Since mutiple course of action is taken is such circumstances, responses under the same

were mapped. The responses were as under .Though the respondents used options like

consulting the ASHA/ Anganwadi karyakarta or the nurse, it seems a lot of time and effort is

also wasted in the processes like: tie amulet (tabeez) to the child, visiting quack doctor etc.

Graph 41: Action taken at the community level if the child is not growing well/ is weak

0 10 20 30 40 50 60 70

Every

month

8-10

times

6-7 times 4-5 times 2-3 times Do not

know

62%

26%

1% 1% 2% 8%

0 20 40 60 80

Consult elders in the family

Do puja for the proper growth of child

Take the child to a quack

Tie amulet (tabeez) to the child

Consult ANM

Consult private doctor

Take the child to ASHA/Anganwadi

karyakarta

Take the child to PHC/ CHC/ District

hospital

37%

50%

24%

35%

68%

61%

72%

42%




3.8 Vaccination/ Immunization of children:

While 81 % of the respondents mentioned that they have got their children vaccinated 19%

mentioned that they could not get the children vaccinated.

Graph 42: Vaccination /Immunization among Saharia and Non-Saharia

Overall 81 % of the respondents mentioned that they got their children immunized however

only 70 % of the respondents from the Saharia community got their children vaccinated.

Effort was done to look at the vaccination card to verify the actual status of vaccination. The

vaccination card was available with only in 37 % of the cases. It was found that there was

lack of continuity in the schedule of vaccination and the vaccination was not completed

properly in majority of the cases. Therefore even in cases where it has been reported that

vaccination has taken place, there is a problem that complete vaccination as per schedule

has not been adhered to. The common reasons for being unable to get the children

vaccinated were migration to other places for work, they had gone to the field for work as

agricultural labourer, the mother of the child had gone to maternal home and in certain cases

the AWW/ANM would not come to the village on time as the village was in remote location.

Graph 43: Vaccination card available among Saharia and Non- Saharia

70%

91% 81%

0

20

40

60

80

100


34%

40%

37%

30

32

34

36

38

40

42





Graph 44: Reason why vaccination was incomplete

Anaemia: When the respondents were asked if they got the medicine to control anaemia

among adolescent girls and pregnant women, almost 90 % of the respondents mentioned that

they received such medicine.

Iron and Folic Acid (IFA) Prophylaxis (Action taken to prevent anaemia): Iron and Folic

acid is given to children via the Anganwadi centre. About 93 % of the respondents from

Saharia community and 86 % of the respondents from the Non-Saharia community sent their

children to Anganwadi centres. Majority of the respondents who sent the children to

Anganwadi were aware about the iron and folic acid (IFA) being provided to the children at

the Anganwadi centre.

Deworming: Almost 77 % of the respondents mentioned that deworming medicines were

given to the children

3.9 Nutrition Rehabilitation Centre (NRC):

About 15 % of the respondents reported to have availed the facility of Nutrition

Rehabilitation Centre. Almost all of the respondents who availed the services of NRC

responded stating that the NRC was overall clean, the nurse and staff took good care of them,

and they also received formula feed for the child and good meals for the attendant. Majority

of the respondents who availed the services of NRC mentioned that the services of NRC were

ANM /

Anganwari

karyakarta does

not come on

time

14%

We go to field

for majdoori

35%

Migration/

went out of

the village

51%




good. The respondents were also asked if they received the money on account of loss in

wages from the NRC. Majority (86 %) of those respondents who were admitted in the NRC

received the money on account of loss of wages during admission to NRC. Though the

nutrition rehabilitation centre provides an effective mechanism to ensure that the mother and

the child are taken care of and the weight and other parameters of the child are regularly

monitored, there is still a risk of relapse after being discharged from the NRC 13

.

3.10 Alcoholism and consumption of tobacco:

About 71 % of total households surveyed spent at least some portion of the expenditure on

alcohol or tobacco. The problem of alcohol and consumption of tobacco was found to be very

high among the Saharia community with approximately 83 % of the Saharia respondents

spending at least some amount regularly on a monthly basis on alcohol/tobacco products

while approximately 59 % of the households from Non-Saharia community reported

spending at least some amount on amount regularly on a monthly basis on alcohol/tobacco

products.

Graph 45: Alcoholism and Consumption of tobacco among Saharia and Non-Saharia

3.11 Observations during the field visit:

During the course of visit to Karahal block it was observed that some of the hand-pumps and

taps were broken also the overall cleanliness in the villages was not very good with children

were found playing in unclean surroundings, there was lack of connectivity and water logging

in certain places and animal excreta.

83%

59% 71%

0

20

40

60

80

100





Discussion was held with D.P.O Mahila Evam Bal Vikas to know in detail about the

initiatives taken in the district to monitor the problem of malnutrition in the district. Duties

have been assigned to various staff members of the government departments to visit

respective anganwadi and report about the facility and functioning of the Anganwadi along

with suggestions for improvement. The same was found to be in practice. Monitoring of the

malnutrition related issue was done by including this issue in Time-Limit (T/L) meeting.




Occupation and other issues: The major season of earning is at the time of sowing of seeds

and also at the time of reaping the produce. They also go to the forest to collect tendu patta

and gum .The problem of alcoholism was also reported by the community. Certain issues are

found regarding quality of water available in the community. The problem of eating pan-

masala was found among men and women also .The eldest sibling was found to be available

taking care while the mother would go to the forest for collecting firewood, tendu patta, herbs

etc.

Visit to Anganwadi: Visit was undertaken to Anganwadi. Immunization was done on 3rd

Tuesday of every month. Initially a meal of sattu was given to the children. Anganwadi

registers were maintained and the children were checked to verify their weight and the mid

upper arm circumference was measured to identify the cases suffering with severe and acute

malnutrition. (SAM). The meal of puri and kheer was provided. The take home ration was

also distributed. The anganwadi had sufficient supply of Take home ration and ORS.

Anganwadi at Karahal block, Sheopur




Community Health Centre and Nutrition Rehabilitation Centre at Karahal: Visit was also

undertaken Community Health Centre and Nutrition Rehabilitation Centre at Karahal. At the

time of the visit about 35 patients were admitted in the NRC which had a capacity of 20 beds.

Arrangement for beds was made from the neighbouring chatrawaas. The weight of the child

is taken at the time of admission and growth graph is maintained. The child is put to the

prescribed diet. The facility also provided food for the mothers (including daliya, dal, roti,

rice and vegetables) two times a day.

During discussion with the members of the community it was understood that they go for

migration during harvesting during the months of February to April every year. This leads to

depletion in their nutrition status. The Anganwadi and the NRC have to work harder towards

improving their nutrition status.

Nutrition Rehabilitation Centre – Karahal Block, Sheopur




Food being served at Nutrition Rehabilitation Centre Karahal block, Sheopur

During discussion with a mother admitted at the NRC it was known that she had gone a

neighbouring village for wheat harvesting for two months. They also go to the jungle to

collect local gums. There are two varieties of gums that they collect form the forest. The gum

(rubber) is collected as a sap from the trees. It is sold for Rs 200 per Kg approximately. It was

informed that the women have made a self help group for the same. They also collect another

type of Gum (edible) from the forest which they sell for Rs 150-200 per kg. The detail of

items commonly gathered from the forest and sold are as under:

Commonly available Forest

Product

Rate at which it is sold

Gum resins (rubber) Rs 200 per kg

Gum resins(edible) Rs 150-200 per kg

Kamarkas Rs 300 per Kg

Amla Rs 50-60 per kg

3.12 MNREGA in the district:

An effort was done to analyze the impact of MNREGA in the state and district. The data for

the same was downloaded from the MNREGA website regarding the district wise households

to whom work was provided during the financial year 2016-17.

Employment was provided via MNREGA to approximately 28 lakh house-holds via

MNREGA during the financial year 2016-17. Sheopur district ranks at number 36 among all

the 51 districts of Madhya Pradesh in terms of employment provided to the households. The

Karahal block has the highest (63.08 %) of the population of Scheduled Tribes (rural)




population among the total population of the block, thus an analysis was done of the

livelihood provided under MNREGA for each of the block in Sheopur district.

Out of 35,238 households to which employment was provided via MNREGA in year

2016-17 for the Sheopur district, approximately 18 % of households of Karahal block got

employment under MNREGA.

On analysis of block wise households who demanded for work month wise under

MNREGA and comparing the same with the work under MNREGA given to them month

wise during financial year 2016-17, 81% of those who demanded work from Vijaypur Block

were given work under MNREGA, however only 63% of those who demanded work from

Karahal Block were given work under MNREGA (Details are available in Annexure 7).




Chapter 4

Findings against objectives of the study

The overall objective of the study was to understand the underlying causes of

malnutrition among the children in the study area.

It was found that the children from a Saharia household were almost twice more prone

to the problem of malnutrition than their Non-Saharia counterparts. This vulnerability

is due to their poor economic conditions.

The findings against each of the objective are as under:

Objective 1(a): To assess the socio cultural and economic status, means of livelihood,

status of family and food security situation in the study area.

On analysis of the main occupation among people residing in the district it was found that

only 21.53% of population of the Karahal block is cultivators while the percentage of

workers involved in cultivation is as high as 51.56% in the Vijaypur block of the Sheopur

district. The majority of the population of the Karahal block 62.63 % is engaged as

agricultural labourers.

There is a very high percentage of ST population in the area and the level of literacy is also

very low. Almost 73% of the respondents from the Saharia community were illiterate

and almost 65 % of the respondents from the Non- Saharia community were illiterates.

Approximately 84 % of the respondents live in nuclear family. Though overall 69% of the

respondents worked as labourers, when the same was analyzed at the community level, huge

majority (90%) the respondents from the Saharia community worked as labourers while 48%

among the Non- Saharia worked as labourers.

Approximately 52% of the respondents had some land. But among Saharia community

only 39% of the respondents had some land while among the Non-Saharia community

approximately 65 % of the respondents had land. However approximately 75% of those

who had land were marginal farmers .Huge majority around 91% of the respondents

mentioned their annual family income was less than Rs 50,000.

Migration is a very significant aspect of the community in the area. It has an impact on the






related options available in the area. Overall 34% of the household migrated to

neighbouring places for work. However among the Saharia households approximately

56% migrated for work while only 12% of those from Non-Saharia households

migrated for work.

Almost 65% of the respondents had BPL card. On analysis between the Saharia and Non-

Saharia community it was found that 77% of the respondents from the Saharia community

had BPL card while 52 % of the respondents from the Non- Saharia community held BPL

card. Approximately 56 % of the respondents from the Saharia community had three or more

children.

Daily food consumption at the community level: Almost all the respondents reported

consumption of Rotis on a daily basis, while 72% of the respondents included Dal in their

daily diet. Only 30% of the respondents consumed vegetables on a regular basis while only

17 % of them consumed Rice and 9% of the respondents reported regular consumption of

milk. Approximately 35 % of the respondents mentioned that they consumed milk at least

sometime. Consumption of milk, egg and meat in the family: Milk is a good source of

calcium while eggs are a good source of protein. It is essential to identify the pattern of

consumption of milk, eggs and meat in the family to get a fair idea of the overall nutrition

position in the households. Consumption of milk was found to be very low among the Saharia

community as compared to their Non-Saharia counterparts. Only 6% of the respondents

consumed eggs. 17% of the respondents consumed hen’s meat while 7% of the respondents

consumed the meat of goat.

Food consumption pattern among the Saharia and Non –Saharia community: When

comparison was done among the Saharia and Non-Saharia households, it was found that only

24 % of the Saharia households consumed vegetables on a regular basis while this percentage

among the Non-Saharia was 37%. Only 11% of the households of Saharia community

consume Rice on regular basis while this percentage among the Non-Saharia was 23%. The

consumption of milk was also found to be much lower among the Saharia families (11% in

Saharia against 60 % in Non- Saharia).

Objective 1(b) : To assess coverage of basic child health services like immunization,

supplementary nutrition, deworming, iron and folic acid supplementation, treatment of

common ailments, use of ORS and Zinc during diarrhoea, treatment of Acute

Respiratory Infections etc in children from Saharia and Non-Saharia families




A comparative picture of the healthcare structure in Sheopur is given below:

Name of

Block

Number of

Community

Health

Centre

Number of

Primary

Health

Centre

Sanctioned

post at

PHC/

actually

posted

ANM

sanctioned

for the

block /

actually

posted

ASHA

sanctioned

for the

block

Nutrition

Rehabilitation

Centre

Vijaypur 1 3 27/12 31/24 246 NRC ,

Vijaypur

Karahal 1 1 7/4 26/19 130 NRC. Karahal

Sheopur 1 6 39/24 33/29 240 NRC ,

District

Hospital ,

Sheopur

Immunization: Information was gathered whether the children were vaccinated for

common illnesses. While 81 % of the respondents mentioned that they have got their children

vaccinated while 19 % mentioned that they could not get the children vaccinated. However

only 70 % of the households among the Saharia community got their children vaccinated.

The common reasons for being unable to get the children vaccinated were:

palayan or migration

they had gone to the field for work as agricultural labourer

the mother of the child had gone to maternal home

In certain cases the AWW / ANM would not come to the village on time as the village

was in remote location.

Effort was done to look at the vaccination card to verify the actual status of vaccination. The

vaccination card was available with only in 37 % of the cases. It was found that there was

lack of continuity in the schedule of vaccination and the vaccination was not completed

properly in majority of the cases. Therefore even in cases where it has been reported that

vaccination has taken place but there is a problem that complete vaccination as per schedule

has not been adhered to.

Supplementary nutrition: 68 % of the women actually followed the advice of consuming

additional food during pregnancy and while they were feeding the baby with breast milk

during pregnancy .Among the 68% of the women who consumed certain additional eatables

40% of the respondents consumed additional fruits, 34 % took additional vegetables, and

14% took additional milk while 12% increased the quantity of the daily food. However it was

noticed that the additional food consumption was up to a maximum of 3-6 months and not

during the entire period of pregnancy to be continued while feeding the child as well.




Majority of the respondents introduced complementary feed to the child when the child was

around 6-7 months of age.

Deworming: Almost 77 % of the respondents mentioned that deworming medicines were

given to the children

Anaemia: When the respondents were asked if they got the medicine to control anaemia

among adolescent girls and pregnant women, almost 90 % of the respondents mentioned that

they received such medicine.

Iron and Folic Acid (IFA) Prophylaxis (Action taken to prevent anaemia): Iron and Folic

acid is given to children via the Anganwadi centre. About 93 % of the respondents from

Saharia community and 86 % of the respondents from the Non-Saharia community sent their

children to Anganwadi centres. Majority of the respondents who sent the children to

Anganwadi were aware about the iron and folic acid (IFA) being provided to the children at

the Anganwadi centre.

Frequency of illness among children: One of the parameter for health and overall well

being is absence of disease. An effort was made to analyze the frequency of illness reported

at the community level. The most commonly reported illness were: fever, diarrhoea and

common cold. The highest number of respondents (83%) mentioned that the child suffered

from diarrhoea during the past one year, this was followed by fever (79 %) and common cold

(45%). Efforts were also made to view further the frequency of occurrence of the illness.

Majority of the children suffered with the above mentioned illnesses on an average 2-5 times

in a year. The members from the Saharia community reported marginally higher incidence of

illness as compared to Non-Saharia 86 % of the respondents of the Saharia community

mentioned that the children suffer from diarrhoea/ vomiting, while 42 % of respondents

mentioned that their children suffer with sardi/ khansi and 76 % of the respondents from the

Saharia community that their children suffered with fever.

Action taken when child fell ill: An effort was further made to analyze the treatment /

options were exercised by respondents when the children fell ill .Multiple responses were

taken from the respondents as it is possible that an individual may take more than one course

of action during illness. 34% of the respondents mention that they normally do not take much

attention of common illness like fever, diarrhoea, and common cold and they children get

cured in some time. As high as 39% of the respondents mentioned that they opted for jhaad-

phoonk practices while 21% of the respondents used home remedies for medication.




Action taken when child suffered with diarrhoea: The children in the community

frequently suffer with diarrhoea, information was collected on what practices are followed in

the community when the children suffer from diarrhoea. Multiple responses were collected

from the respondents. Approximately 84 % of the respondents gave ORS to the children. The

major source of getting ORS was ASHA/ AWW .Almost 57 % of the respondents gave the

children a solution of water salt and sugar. Approximately 8 % of respondents mentioned that

they gave small quantity of opium to the child suffering from diarrhoea while approximately

20 % of the respondents used jadi-booti for the purpose of treatment of diarrhoea.

Action taken when child suffered with respiratory infections: The respondents were also

asked what action was taken when the child suffered with respiratory or other illnesses.

Multiple course of action is taken in such circumstances. Approximately 50 % respondents

took the child to Public Health Centre or Community Health Centre while 44 % showed the

child private facility.

Objective 1(c): To assess the knowledge, attitude and practice of the family regarding

the infant, the young child's nutrition and common childhood illnesses.

68 % of the women actually followed the advice of consuming additional food during

pregnancy and while they were feeding the baby with breast milk during pregnancy .Among

the 68% of the women who consumed certain additional eatables, 40% of the respondents

consumed additional fruits, 34 % took additional vegetables, and 14% took additional milk

while 12% increased the quantity of the daily food. However it was noticed that the

additional food consumption was up to a maximum of 3-6 months and not during the entire

period of pregnancy to be continued while feeding the child as well.

The respondents were asked whether they were aware of the need for taking care during

pregnancy .Further the respondents were asked about the care /precautions actually taken by

them during pregnancy. This was done in order to compare the awareness with the practice

actually followed. 83% of respondents felt that they need to take adequate rest while only

64% of the respondent’s actually took adequate rest during pregnancy. While only 53% of

respondents felt they should abstain from heavy work during pregnancy, actually only 42% of

the women refrained from doing heavy work during pregnancy.

92 % of the respondents said they gave initial colostrum to the children. 78% of the

respondents gave exclusive breast milk to the babies up to the age of 6 months while 21% of




the respondents gave water also in addition to mother’s milk. Only one percent of the

respondents gave milk (mixed with water) from outside in addition to mother’s milk.

47% of the respondents fed the child whenever the child cried for food, about 43 % of the

respondents fed the child up to 4-5 times a day while only 10 % of the respondents fed the

child every 2-3 hours during day and night also. Majority of the respondents mentioned that

the child was 6 to 7 months of age when complementary food was introduced.

Information was also gathered if they used any of the practices like witchcraft or other course

of action taken when the child fell ill, since multiple course of action can be taken in such

circumstance, multiple responses were taken from the respondents. 41% of the respondents

went for jhad-phoonk, 28 % of the respondents showed the child to any baba/phakeer, 28 %

took the child to religious places while 17 % of the respondents used the practices of

witchcraft.The respondents from Saharia community have marginally higher inclination

towards such practices.

Objective 1(d): To assess the uptake of key maternal health services like antenatal,

intra-natal and postnatal services and the ICDS centres in the study area.

The respondents showed a very high degree of awareness towards the services provided by

the Anganwadi. The facility of nutritional food is one of the most significant facility that is in

the first recall among the services provided by the Anganwadi. The take home ration (THR)

is one of the mechanisms used in the Anganwadi to ensure that nutritional food is available to

the pregnant and lactating women. An effort was done to identify if the take home ration was

actually consumed by the pregnant women and the children or did they share the same with

the family. 79 % of the respondents said they consumed the Take home ration themselves and

shared the same with the children. A feedback was taken from the respondents regarding the

quality of service provided by the Anganwadi. The overall response was favourable with 56

% of the respondents saying that the services of Anganwadi were good and another 34 %

mentioned that the services provided by the Anganwadi were average.

Objective 2: To evaluate utilization of NRC services and relevance of its geo-physical

location for serving the high burden areas.

About 15 % of the respondents reported to have availed the facility of Nutrition

Rehabilitation Centre. Almost all of the respondents who availed the services of NRC

responded stating that the NRC was overall clean, the nurse and staff took good care of them,

they also received formula feed for the child and good meals for the attendant. Majority of




the respondents who availed the services of NRC mentioned that the services of NRC were

good. The respondents were also asked if they received the money on account of loss in

wages from the NRC. Majority (86 %) of those respondents who were admitted in the NRC

received the money on account of loss of wages during admission to NRC.

The Nutrition Rehabilitation Centre at Karahal block is located adjoining the Community

Health Centre at the Karahal block. Visit was also undertaken Community Health Centre and

Nutrition Rehabilitation Centre at Karahal. At the time of the visit about 35 patients were

admitted in the NRC which had a capacity of 20 beds. Arrangement for beds was made from

the neighbouring chatrawaas. The weight of the child is taken at the time of admission and

weight growth graph is maintained. The child is put to the prescribed diet. The facility also

provided food for the mothers including daliya, dal, roti, rice and vegetables two times a day.

The Nutrition Rehabilitation Centre, Karahal is located adjoining the Community Health

Centre which is beneficial that the services and advice of the doctors at Community Health

Centre can also be used for the benefit of the children. Thus the location of the NRC seems

appropriate. The overall bed occupancy of the NRC was 81 % in the year 2016-17 and 91.4

% during the year 2017-18. Majority of the patients who were referred to the NRC were sent

by the Anganwadi workers. The NRC staff should council the mothers for the planning

procedures which is lacking.

Test for significance: The test for significance of factors affecting malnutrition in the

children of the community was done using chi-square test using p value at 95 % of accuracy

and degree of freedom = 1, cross-tabulation of data was done and the values were determined

using statistical formulas. The following factors were found to have significant impact on

malnutrition among children: households living Below the Poverty line, Occupation as

labourers and migration. Mothers who took some additional food during pregnancy

and while feeding the child with breast milk were able to prevent malnutrition among

their children to a great extent.




Chapter 5

Recommendations

Based on the primary information from questionnaire, analysis of the data received from

different agencies and interactions at field level, the following are the recommendations to

address malnutrition among children in Sheopur district. These are stated under four broad

categories to emphasise inter sectoral co ordination among departments:

1. EXPANDING LIVELIHOOD OPPORTUNITIES

2. BETTER EDUCATION

3. IMPROVED ACCESS TO HEALTH CARE

4. EXTENSION EFFORTS AT COMMUNITY LEVEL

1. EXPANDING LIVELIHOOD OPPORTUNITIES :

(1.1)Creating better employment opportunities for the vulnerable tribal population: It

was found that the children from a Saharia household were almost twice more prone to the

problem of malnutrition than their Non-Saharia counterparts. This vulnerability is due to their

poor economic conditions. There is a need for better targeting of employment programs.

The following table gives a comparative picture:-

Class Illiterate Land holding Working as

labourers

Migration

Saharia 73 % 39 % 90 % 56 %

Non- Saharia 65% 65 % 48% 12 %

The above table clearly brings out the vulnerability of the community on social and economic

parameters.

Saharia is notified as the Primitive Tribe Group (PTG) in Madhya Pradesh. This being

the scenario, it is strongly recommended that the government should have a higher allocation

for PTG predominant blocks. Three tribes of Madhya Pradesh Baiga, Bhariya and Saharia

have been declared specific backward tribes by the Government of India. Their total

population is very small when seen as a ratio of the total population in the state. This sub

group within the larger ST population is facing the most severe challenge of livelihood and

malnutrition. In the study it’s seen that very clearly that the in Poor wage employment

opportunities for Saharias is affecting them in all aspects of their life. Thus the following

interventions can help in different programmes:




(1.1) MNREGA: The government implements a series of rural development activities to

generate employment for the rural poor and alleviate poverty. MNREGA, which ensures 100

days of employment to all poor adult population in the country, is a significant step in this

regard. There is a need to continue the focus on the same. However, it was found that within

the district the ST dominated Karahal performed poor on availability of funds for MNREGA.

Sheopur district ranks at number 36 among all the 51 districts of Madhya Pradesh in terms of

employment provided to the households. The Karahal block has the highest (63.08 %) of the

population of Scheduled Tribes (rural) population .Out of 35,238 households to which

employment was provided via MNREGA in year 2016-17 for the Sheopur district,

approximately 18 % of households of Karahal block got employment under MNREGA. In the

non ST dominated Vijaypur 81 % of the households who demanded work under MNREGA

got work under MNREGA, while in Karahal block 62% of household who demanded work

under MNREGA got work under MNREGA. Unemployment being higher in Karahal makes

them more vulnerable to migration. The migration in the Karahal block was found to be

generally for duration of about 2-3 months in a year.

It is proposed that the quota of MNREGA allocation for 100 days may be increased to

150 -200 days in the year for the next 5 years in Sheopur district. There are instances

when the MNREGA allocation of days has been increased in certain duration to take care of

the immediate distress like drought. Saharia and other PTGs being a special class needs

preferential allocation so that they could sustain themselves and not take recourse to

migration. It is proposed that the special package under MNREGA should remain at least for

5 years when it can be reviewed again. Thus increased focus on MNREGA will also help to

address the problem of migration to a great extent.

(1.2) Expanding Employment opportunities in rural areas: - The Panchayat and Rural

Development Department Govt of Madhya Pradesh is doing a series of activities for the

benefit of the people living in the area like creation of self-help groups, promotion of

livelihood related activities like animal husbandry, making washing powder, Agarbattis soap,

Sanitary napkins, stitching, making of Dona – Pattal etc .Such activities need to be

strengthened. There are also schemes that provide loan for livelihood generation. These

schemes are carried out by multiple departments targeting different interest groups .These

activities need to done regularly and monitoring of the same is required.

(1.3) National Rural Livelihoods Mission (NRLM): NRLM promotes and supports

collectives towards sustainable livelihoods of the poor (CSLP) around key livelihoods. These




collectives offer their members access to livelihoods knowledge, skills, technology, market

intelligence, risk management products and credit support through their SHGs and

federations. Support of NRLM may be taken in enhancing livelihood opportunities in the

region.

(1.4) Comprehensive package involving all stakeholders departments for Primitive

Tribe Groups: The possibility of introducing a crash program for the next 4-5 years needs

to be explored in order to address livelihood related problem and nutrition requirement in the

region. Several instances where found where the respondents were aware that it is advised

that certain precautions and care like additional nutritious food to be taken by the pregnant

women , avoid heavy physical labour etc should be taken during pregnancy, however they

were unable to do so in practice. A lot of it has to do with the lack of employment

opportunity in the area. If they are able to get enough food and nutrition such problems are

likely to be minimized. A holistic convergent plan is required, that will include government

departments like the Tribal Welfare Department, Department of Women and Child

development, Department of Health and Family Welfare, Department of Agriculture and

Horticulture, Public Health Engineering Department, Forest department and Panchayat and

Rural Development department. Saharias are the largest group of Primitive Tribe Groups in

Madhya Pradesh .This being a small proportion of the total population, it will not be much of

a burden on funds, this package will not put a big additional burden on them as only the gaps

need to be addressed.

With effect from December 2017 onwards the Government has initiated a cash assistance

scheme of Rs 1,000 per month to each of the families of special backward scheduled tribes

(STs) as part of its efforts to eliminate malnutrition among the communities. The amount of

Rs 1000 per month is being provided to special backward ST communities, including

Saharia, Baiga and Bharia, to address the problem of malnutrition among them. The amount

is being deposited in the bank account of the woman head of the family to be used for buying

nutritious food items. This initiative of the Government is likely benefit the community in

addressing the problem of malnutrition among the Saharia and other tribes also.

(1.5) Identifying and expanding the MFP (Minor Forest Produce) activities in PTGs

areas: Approximately 60 % of the area of Sheopur district is under forest cover. Thus it is

essential to take the benefit of forest economy to the fullest in a comprehensive manner.




Collecting Tendu Patta is one of the commonly used forest based source of livelihood for the

people in this area. This is a seasonal operation done in the months of May and June for only

45 to 50 days in a year. Enhanced efforts are required to be done in co-ordination with the

Minor Forest Produce Development Corporation working in the state.

Forests provide a range of marketable products like resins (gum), bahera, nagar motha, edible

gond, satawar, mahua etc. Many of the locally collected medicinal herbs fetch a good price in

open markets but the tribal people end up selling these products to the intermediaries at

abysmally lower prices. The support for marketing and value addition by creating processing

facilities would enhance the income in the community. This is an activity which is fully

privatized for a long time. This is also resulting in rapid depletion of these medicinal

products. It is recommended that a special plan is drawn by the MFP cooperative federation,

which has the resources, to identify all marketable Minor Forest Products and create Self

Help Groups (SHGs) for them. Such SHGs should be empowered to scientifically harvest,

process and sell at competitive prices to the larger markets outside Karahal.

(1.6)Enhanced focus on agriculture: The study has revealed the average land holding of the

farmers is about one hectare. The farmers belonging to the Saharia Community have a land

holding of less than one hectare on an average. The Karahal block receives less rainfall. Only

12.79 % of the land in the Karahal block is cultivable as a percentage of total area. Thus

enhanced efforts are required to improve the availability of water and increase the cultivable

area.

The land holding status of the focus group needs to be kept in mind while planning a strategy

for agriculture development. The benefits of beneficiaries’ oriented schemes aimed at

enhanced productivity need to be taken up. The department needs to plan a special 3 to 5

years intensive multipronged attack on different fronts i.e. Seeds, Land management,

irrigation, pumps and other water lifting devices, Watershed management, market

development, expanding storage ,farm mechanisation practices etc.

Saharias being a special focus group the State government i.e., the Agriculture Department

should pay special attention to them and other similar marginalized farmers. The land in

Karahal being of not too good quality, the agriculture production enhancement strategy will

have to include Horticulture, Forestry and Agro-Farm Forestry in its mix of practices.




(1.7) Horticulture Crops: There is an urgent need to explore possibility of introduction of

nutritional horticultural crops suitable for the region. According to the report of department

of horticulture, Government of Madhya Pradesh guava, ber, custard-apple (sitaphal) could be

considered a crop under rain fed conditions in the region. Certain other crops recommended

to be grown in the region are seasonal vegetables, coriander, chillies and garlic etc.

2. BETTER EDUCATION

(2.1) Expanding access to Primary education in PTGs areas: It was found that illiteracy in

the sample was quite high. Almost 73 % of the respondents from the Saharia community

were illiterate and almost 65 % of the respondents from the Non- Saharia community were

illiterates.

In spite of presence of schools in the region the overall education situation in the area is not

very encouraging

Block wise

number of

schools

Primary

School

Middle

School

Higher

Secondary

School

High

School

Total Population

Sheopur

Block 326 108 11 18 463

235584

Vijaypur

Block 308 100 11 11 429

215041

Karahal

Block 240 75 9 13 337

129884

Source: Education Portal, Government of Madhya Pradesh

A. Number of girls enrolled in school in the entire district of Sheopur is lesser than the

number of boys registered for education (Source: Education Portal, Government of Madhya

Pradesh, year 2017-18).

B. As illiteracy is the root cause of so many other social issues like poor health / awareness,

poor awareness on safe motherhood, livelihood and related matters. The stark gap should be

plugged in next few years. This will give confidence to general population and empower

them on social issues.

C. An effort for adult education in a drive mode is also needed in the district with special

focus on the Saharia population owing to poor literacy in the region.

3. IMPROVED ACCESS TO HEALTH CARE

(3.1) Enhanced focus on Health and greater convergence with the Women and Child

Development Department: There is a need for expansion of health care services in the




affected area including health care activities including reproductive and child care, pre and

post-natal care, vaccination etc. to deal with women and health related issues.

The tribal community face certain challenges in terms of exclusion which when added to the

problem of poverty aggravate the problem and adds to further vulnerability. The health

service seeking behaviour is improving while they still suffer with the problem of dealing

with quacks, witchcraft etc even when the child suffers with common illness such as fever or

diarrhoea or respiratory track illnesses. A lot of precious time is wasted in such

circumstances.

A comparative picture of the healthcare structure in Sheopur is given below:

Name of

Block

Number of

Community

Health

Centre

Number

of

Primary

Health

Centre

Sanctioned

post at

PHC/

actually

posted

ANM

sanctioned

for the

block /

actually

posted

ASHA

sanctioned

for the

block

Nutrition

Rehabilitation

Centre

Vijaypur 1 3 27/12 31/24 246 NRC ,

Vijaypur

Karahal 1 1 7/4 26/19 130 NRC.

Karahal

Sheopur 1 6 39/24 33/29 240 NRC ,

District

Hospital ,

Sheopur

It was found that the children born in Saharia families are much higher risk of being

malnourished than among those born in Non – Saharia households, this coupled with their

early marriage makes them vulnerable to anaemia and other childhood illnesses. Therefore, it

is recommended that:

a. Intensive health awareness in the target group of expectant mothers / adolescents

needs to be launched in the campaign mode through women and child development

department and health and family welfare department.

b. Filling up infrastructure gaps – this would mean posting of doctors/ other support staff

at the facilities.

c. Creating new CHC/PHC as per the projected needs. The gaps mentioned above need

to be addressed and bridged by new sanctions, better access would improve the access

to health care for the child and the mothers.




The consumption of additional food by the mother during pregnancy / by lactating

mothers was found to have positive impact in lowering the incidence of malnourishment

thus it is desired that the pregnant women/ lactating mothers be encouraged to take

additional diet and consume the take-home-ration.

Looking into the disease pattern and the frequency at which the children in the community

suffer from common illness like diarrhoea, fever and respiratory infections in the region,

there is an immense need for advocacy and reiteration of optimal practices of health and

nutrition especially infant and young child feeding practices. Also there is an urgent need to

enhance the staff and capacity of the PHC and CHC in the region.

The level of literacy was found to be very poor in the affected area; almost 73 % of the

Saharia respondents were illiterate while 65% of the Non-Saharia respondents were illiterate.

Therefore any IEC literature will not be of much use. There is an urgent need to make use of

mobile vehicle with loudspeakers having announcement regarding health facility and

hygiene, since the personal hygiene was not found to be very good during the course of the

visits undertaken to the area. It is essential that the audio-visual IEC is in local language and

local actors as used for the same. Radio station Vanya located in Sesaipura (Sheopur)

provides a great window of opportunity as it makes programmes in Saharia dialect which is

easily understood by the community. Health related messages could be propagated using his

medium.

The Karahal block is one among the 89 tribal blocks identified in Madhya Pradesh. Iron and

Iodised double fortified salt distribution has been initiated in the 89 tribal blocks of Madhya

Pradesh. Increased emphasis should be given on the same as it is likely to tackle the issue of

iron and iodine deficiency in the region.

(3.2) Vaccination: It was observed that in most of the cases the vaccination was incomplete

i.e. vaccination was started however the schedule of vaccination was not adhered to. An

increased effort is required to address this issue in the region. The schedule of vaccination

should be regularly monitored and adhered to.

(3.3) Family Planning: Family Planning initiatives do not seem to be very effective in the

region with almost 75 % of the respondents mentioning that they did not use any method of

family planning .The Saharia community reported even lower inclination towards family

planning with only 22 % of the respondents from the Saharia community adopting methods

of family planning. At the community level also when the respondents were asked about their




opinion about how many children a couple should have almost 52 % were of the opinion that

a couple should have 3 or more children. In such circumstances it is essential that the AWW,

ASHA , ANM and other functionaries working the region should do more efforts to inform

and encourage the community to adopt family planning practices.

(3.4) Child feeding practices : According to the Infant and Young Child Feeding

Guidelines, 2016 published by the Indian Academy of Paediatrics, after the child reached six

months of age introduction of optimal complementary feeding should be practiced preferably

with energy dense, home-made food. Breastfeeding should be continued minimum for 2 years

and beyond. However, in almost 49 % of the cases feeding of breast milk to the child was not

continued till the child reached two years of age. Thus it is essential to encourage the optimal

feeding practices for the children at the community level.

(3.5) Opportunity under Poshan Abhiyaan: The National Nutrition Mission (NNM) was

set up in December 2017 with a three year budget of Rs.9046.17 Crore commencing from

2017-18. All the States and districts will be covered in a phased manner under the mission.

The district of Sheopur is among the 315 districts identified under Phase –I of the

programme. Total 37 districts of Madhya Pradesh fall under phase-I of the programme.

Poshan Abhiyaan the flagship programme of the Ministry of Women and Child Development

(MWCD), Government of India, ensures convergence with various programmes i.e.,

Anganwadi Services, Pradhan Mantri Matru Vandana Yojana (PMMVY), Scheme for

Adolescent Girls (SAG) of MWCD Janani Suraksha Yojana (JSY), National Health Mission

(NHM), Swachh - Bharat Mission, Public Distribution System (PDS), Department Food &

Public Distribution, Mahatma Gandhi National Rural Employment Guarantee Scheme

(MGNREGS) and Ministry of Drinking Water & Sanitation.

The Poshan Abhiyaan focuses to lay emphasis on the first 1000 days of the child, which

includes the nine months of pregnancy, six months of exclusive breastfeeding and the period

from 6 months to 2 years to ensure focused interventions on addressing under nutrition.

Besides increasing the birth weight, it will help reduce both Infant Mortality Rate (IMR) and

Maternal Mortality Rate (MMR). Additional one year of sustained intervention (till the age of

3 years) would ensure that the gains of the first 1000 days are consolidated. Attention is also

given on children in the age group of 3-6 years for their overall development through the

platform of the Anganwadi Services.

The challenges in the region call for greater convergence in the region among the




department of Health and Family Welfare and Women and Child Development

department, Government of Madhya Pradesh.

(3.6) Opportunity in Ujwalla scheme: During the course of the field visits, it was observed

that the women would go to forest or walk long distances to get firewood. The women also

face a risk of being attacked or assaulted while they go to the forest alone to collect firewood.

The Ujwalla scheme offers a window of opportunity where by the women would not be

required to go to the forest to collect firewood. This would mean that the women stays at

home relatively longer and contributes to the well-being of the child. The respondents also

mentioned one of the reasons for not getting the children vaccinated was they had to go to the

jungle to get fire wood. This will also improve the vaccination and overall status of the

children.

4. EXTENSION EFFORTS AT COMMUNITY LEVEL

(4.1)Public Distribution System: The Public Distribution System contributes significantly

in the provision of food security. Public Distribution System in the country enables the

supply of food grains to the poor at a subsidized price. The importance of public distribution

system cannot be emphasized enough in an area facing risk of malnutrition. In such

circumstances it becomes increasingly important that we continue to focus on the effective

implementation of the public distribution system. In such circumstances it is recommended

that increased allocation of PDS be given to families having severely underweight children

and for and SAM children discharged from Nutrition Rehabilitation Centres.

(4.2) Involvement at all levels in the monitoring of efforts to reduce malnutrition:

Intensive monitoring is required at all levels including District Collector, CEO Zilla

Panchayat, Saharia Vikas Pradhikaran, Chief Medical Officer, Block Medical Officer, Staff

at Nutrition Rehabilitation Centre, Community Health Centre, Primary Health Centre, ANMs,

ASHA Karyakarta, Anganwadi Karyakarta etc need work in co-ordination towards the aim of

reducing malnutrition in the area. Intensive monitoring would be required to ensure that the

problem of malnutrition is addressed properly in the region.

During the course of field visit to the region it was informed that duties have been assigned to

various staff members of the government departments to visit respective anganwadi and




report about the facility and functioning of the anganwadi along with suggestions for

improvement. Also, monitoring of the malnutrition related issue was being done by

including this issue in Time-Limit (T/L) meeting. Though it is heartening to know that that

progress on the front of malnutrition is being regularly monitored, there is a felt need for

inclusion of standard monthly monitorable indicators of malnutrition and its corollaries in the

T/L meeting to make the monitoring mechanism more effective.

(4.3) Campaign against substance abuse: The study showed that problem of substance

abuse, consumption of alcohol and tobacco was found among the Saharia community as well

as Non- Saharias:

Problem of consumption of alcohol and tobacco

Saharia 83 %

Non- Saharia 59 %

The problem is more acute among the Saharia community. It is another drain on the limited

income apart for making them vulnerable to diseases and poor health. A campaign needs to

be taken to address this issue. The campaign needs to be supplemented with appropriate

educational and de-addition interventions also. Adult education program should be planned in

the region where special focus should be given to educate the community about good health

practices and the ill effects of alcohol and tobacco there is an urgent need to focus on de-

addiction and counselling of the household’s resident in the region about the ill- effects of

alcohol and usage of tobacco. Local youth who understand the local issues better could be

counselled and involved in the process.

(4.4) Greater use of Vanya radio station: To address the specifics needs of the tribal

community in local languages resource is available in the form of Vanya radio station to

enhance community participation. It focuses on programs centred on tribal lifestyle, culture,

society, traditions, folk resources etc.Radio station Vanya located in Sesaipura (Sheopur)

provides a great window of opportunity as it makes programmes in Saharia dialect which is

easily understood by the community. This communication medium may be used more

aggressively to communicate information on other aspects including hygiene, livelihood etc

to the community.




(4.5) strengthening of infrastructure of roads in the region: The network of roads in the

region is poor with several villages not being connected by proper roads. As mentioned in the

District Census Handbook on Madhya Pradesh – Sheopur Census of India 2011 only 180 out

of the 607 villages in the district were connected by road. Thus it very essential to strengthen

roads and transport facilities in the region. With greater access and road connectivity the

residents of the region will have greater access to health and other services.

(4.6) Banking and Thrift facility: The overall availability of banking and credit facilities in

the region was not very encouraging. Not many commercial / co-operative banks are active in

the region. The presence of Agricultural Credit Societies and banks in Karahal block is even

lower when compared with the other blocks in the district. Thus it is essential that more

Regional Rural Banks and other institutions become active in the region to support income

generation activities in the region.

Name of Block Number of villages Banks Agricultural Credit

Societies

Vijaypur 162 8 14

Sheopur 235 13 33

Karahal 119 2 5

Source: District Census Handbook on Madhya Pradesh – Sheopur

(4.7) Role of NGOs in community development: During the study it was found that Tata

Trust is in touch with the district administration through their NGO Transforming Rural India

and is planning to work in areas of Livelihood, Literacy, Drinking water and forest produce.

This needs to be followed up vigorously by the local administration. There is a great scope of

work from the Corporates who may be willing to work in the region under the domain of

Corporate Social Responsibility. This opportunity need to be explored further by the district

administration for the overall benefit of the people.




References:

1. Operational guidelines on facility based management of children with severe acute malnutrition

by ministry of health and family welfare, Government of India, 2011

2. Dinachandra Singh K, Alagarajan M, Ladusingh L (2015) What Explains Child Malnutrition of

Indigenous People of Northeast India? PLoS ONE 10(6): e0130567

3. United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-

World Bank Joint Child Malnutrition Estimates. 2017 (UNICEF, New York; WHO, Geneva; The

World Bank, Washington, DC).

4. Gross R, Webb P. Wasting time for wasted children: severe child undernutrition must be resolved

in non-emergency settings. The Lancet. 2006;367:1209–11.

5. Mishra V, Retherford RD. Does biofuel smoke contribute to anaemia and stunting in early

childhood? International Journal of Epidemiology. 2007;36(1):117–29. pmid:17085456

6. Shaw JCL. Malnutrition in very low birth-weight, pre-term infants. Proceedings of the Nutrition

Society. 1974;33:103. pmid:4477386

7. Kimberly D, Ernst MD, Paula G, Radmacher MS, Salisa T, Rafail RD, et al. Postnatal

Malnutrition of Extremely Low Birth-Weight Infants With Catch-Up Growth Postdischarge.

Journal of Perinatology. 2003;23:477–482. pmid:13679935

8. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very Low Birth Weight

Outcomes of the National Institute of Child Health and Human Development Neonatal Research

Network, January 1995 Through December 1996. Pediatrics. 2001;107(1):1–8. pmid:11134427

9. Hack M, Klein NK, Taylor HG. Long-term developmental outcomes of low birth weight infants.

Future Child. 1995;5(1):176–96. pmid:7543353

10. District Census Handbook on Madhya Pradesh – Sheopur Census of India 2011 Series -24 part

XII-A

11. Sankhikiya Sanchhep of MP-2012

12. Jila Sankhikiya Pustika-2011

13. RanRanjan Kumar Biswas and A.K. Kapoor- A Study on Mortality Among Saharia – A Primitive

Tribe of Madhya Pradesh- Anthropologist, 5(4): 283-290 (2003)

14. ManDal, Debabrata: Social and economic sensario of a primitive tribe in Madhya Pradesh: 236-

243. In: Tribal Culture and Identity. Chaturbhuj Sahu (Ed.). Sarup & Sons Publication, New Delhi

(1998).

15. Prabhu, Pradip: Social forestry: An adivasi viewpoint: 134143. In: Towards A New Forest Policy:

People’s Right and Environmental Needs. Walter Fernandes and Sharad Kulkarni (Eds.). Indian

Social Institute, New Delhi (1983).

16. Singh, K.S. : The Scheduled Tribes, Volume – III. Oxford University Press, Delhi (1994).

17. Sethi GR, Sachdev HPS, Puri RK. Women’s health and fetal outcome. Indian Pediatr. 1991;

28:1379-92.

18. Narayanan I, Prakash K, Bala S, Verma RK, Gujral VV. Partial supplementation with expressed

breast-milk for prevention of infection in low-birth-weight infants. Lancet. 1980;2:561-3.

19. Shaw JCL. Malnutrition in very low birth-weight, pre-term infants. Proceedings of the Nutrition

Society. 1974;33:103. pmid:4477386

20. Sanghvi U, Thankappan KR, Sarma PS, Sali N. Assessing potential risk factors for child

malnutrition in rural Kerala, India. Journal of Tropical Pediatrics. 2001;47(6):350–5.

pmid:11827303

21. Bhutia D T. Protein energy malnutrition in India: the plight of our under five children. Journal of

Family Medicine and Primary Care. 2014;3(1):63–7. pmid:24791240

22. Meshram II, Arlappa N, Balakrishna N, Mallikharjuna RK, Laxmaiah A, Brahmam GN. Trends in

the prevalence of undernutrition, nutrient and food intake and predictors of undernutrition among

under five year tribal children in India. Asia Pacific Journal of Clinical Nutrition.

2012;21(4):568–76. pmid:23017315




Websites:

1. http://nhm.gov.in/images/pdf/programmes/child-

health/guidelines/operational_guidelines_on_fbmc_with_sam.pdf

2. http://www.who.int/tb/advisory_bodies/impact_measurement_taskforce/meetings/prevalence_sur

vey/psws_probability_prop_size_bierrenbach.pdf

3. http://www.mpwcd.nic.in/web/wcd/sc-ic-icds

4. http://www.crida.in/CP-2012/statewiseplans/madhya%20pradesh/MP18-Sheopur-26.6.2012.pdf

5. http://www.mp.gov.in/web/guest/gridregion- Proposed horticulture crop for Sheopur

6. http://www.indianpediatrics.net/aug2016/703.pdf Infant and Young Child Feeding Guidelines,

2016 recommendations by Infant and Young Child Feeding (IYCF) chapter of Indian Academy of

Pediatrics

7. http://mnregaweb2.nic.in/netnrega/state_html/pmsr.aspx?lflag=local&state_code=17&state_name

=MADHYA+PRADESH&fin_year=2016-2017&page=S&Digest=cUGUCP5k5v60KPElvKN1gw

8. http://www.who.int/mediacentre/factsheets/fs292/en/

9. http://www.educationportal.mp.gov.in/Public/Schools/ssrs/State_Schools.aspx?MP=1

10. http://www.icds-wcd.nic.in/nnm/NNM-Web-Contents/RIGHT-MENU/NNM-States-

Districts/NNM-Districts-315-Phase-I.pdf).Total

11. http://www.icds-wcd.nic.in/nnm/NNM-Web-Contents/LEFT-MENU/ILA/ILA-Guidelines-

English.pdf

Footnotes :

1. Operational guidelines on facility based management of children with severe acute malnutrition by

ministry of health and family welfare, Government of India, 2011

2. National Family Health Survey 4 (NFHS 4 )of India

3. United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-

World Bank Joint Child Malnutrition Estimates. 2017

4. Gross R, Webb P. Wasting time for wasted children: severe child under nutrition must be resolved

in non-emergency settings. The Lancet. 2006;367:1209–11.

5. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very Low Birth Weight

Outcomes of the National Institute of Child Health and Human Development Neonatal Research

Network, January 1995 Through December 1996. Pediatrics. 2001;107(1):1–8. pmid:11134427

6. District Census Handbook on Madhya Pradesh – Sheopur Census of India 2011 Series -24 part XII-

A

7. ManDal, Debabrata: Social and economic sensario of a primitive tribe in Madhya Pradesh: 236-243.

In: Tribal Culture and Identity. Chaturbhuj Sahu (Ed.). Sarup & Sons Publication, New Delhi

(1998).

8. Prabhu, Pradip: Social forestry: An adivasi viewpoint: 134143. In: Towards A New Forest Policy:

People’s Right and Environmental Needs. Walter Fernandes and Sharad Kulkarni (Eds.). Indian

Social Institute, New Delhi (1983).

9. Singh, K.S. : The Scheduled Tribes, Volume – III. Oxford University Press, Delhi (1994).

10. Ranjan Kumar Biswas and A.K. Kapoor- A Study on Mortality Among Saharia – A Primitive

Tribe of Madhya Pradesh- Anthropologist, 5(4): 283-290 (2003)

11. Dietary Guidelines for Indians- A Manual published by National Institute of Nutrition ,

Indian Council of Medical Research , Hyderabad

http://www.ninindia.org/DietaryGuidelinesforNINwebsite.pdf

12. Infant and Young child feeding guidelines 2016,Indian Pediatirics pg 703 Volume 53 August

15,2016 https://www.indianpediatrics.net/aug2016/703.pdf

13. Taneja G, Dixit S, Khatri A K, Yesikar V, Raghunath D, Chourasiya S. A study to evaluate the

effect of nutritional intervention measures on admitted children in selected nutrition rehabilitation

centers of Indore and Ujjain divisions of the state of Madhya Pradesh (India). Indian J Community

Med 2012;37:107-15

http://nhm.gov.in/images/pdf/programmes/child-health/guidelines/operational_guidelines_on_fbmc_with_sam.pdf

http://nhm.gov.in/images/pdf/programmes/child-health/guidelines/operational_guidelines_on_fbmc_with_sam.pdf

http://www.crida.in/CP-2012/statewiseplans/madhya%20pradesh/MP18-Sheopur-26.6.2012.pdf

http://www.mp.gov.in/web/guest/gridregion

http://www.indianpediatrics.net/aug2016/703.pdf

http://mnregaweb2.nic.in/netnrega/state_html/pmsr.aspx?lflag=local&state_code=17&state_name=MADHYA+PRADESH&fin_year=2016-2017&page=S&Digest=cUGUCP5k5v60KPElvKN1gw

http://mnregaweb2.nic.in/netnrega/state_html/pmsr.aspx?lflag=local&state_code=17&state_name=MADHYA+PRADESH&fin_year=2016-2017&page=S&Digest=cUGUCP5k5v60KPElvKN1gw

http://www.who.int/mediacentre/factsheets/fs292/en/

http://www.icds-wcd.nic.in/nnm/NNM-Web-Contents/RIGHT-MENU/NNM-States-Districts/NNM-Districts-315-Phase-I.pdf).Total

http://www.icds-wcd.nic.in/nnm/NNM-Web-Contents/RIGHT-MENU/NNM-States-Districts/NNM-Districts-315-Phase-I.pdf).Total




Annexure 1

National Family Health Survey (NFHS-4, 2015-16) malnutrition in India,

MP and Sheopur

Particulars India Madhya Pradesh Sheopur

Percentage of children under age

of five years who are underweight

(low weight for age).

35.7 42.8 55

Percentage of children under five

who are stunted (height for age).

38.4 42 52.1

Percentage of children under five

years of age who are wasted

(weight for height)

21 25.8 28.1

Percentage of these children who

are severely wasted(weight for

height)

7.5 9.2 9

Source: National Family Health Survey 4, 2015-16




Annexure 2

District Map of Madhya Pradesh

About Sheopur

Climate: The climate here is characterized by a hot summer and general dryness except

during the monsoon and well distributed rainfall in the monsoon season. The winter season

from December to February is followed by summer season from March to mid June. The

period from mid-June to September constitutes the south-west monsoon season. The

succeeding period lasting till the end of November is the post monsoon or retreating monsoon

season. About 83 to 87 percent of the annual rainfall in the district is received during the

south-west monsoon months, (June to September). The spatial variation of rainfall in the

district is not much, July being the rainiest month of the district. After February temperature

increase rapidly till May, which is the hottest month of the year. The mean daily temperature

in May is 40 degree centigrade.

Forest: Forest have vital role in the economy of the district. The total forest area of

Sheopur is 3949 sq. km which is 59.79% to the total area (6606 sq. km) of the district. The




district has 3006 sq. km of reserved forest. There is vast stock of forest products like Tendu

leaf, Timber wood, Mahua, Harra, Lac, Gum and other herbal and medicinal products. The

forest of Sheopur district can be regarded as dry tropical forests.

Agriculture and Animal Husbandry: The principal Kharif crops traditionally grown

in the district are Jowar, Bajra, Soyabean and Tuar. To some extent Rice is also grown. Main

Rabi crops are Wheat, Barley, Gram, Mustard and Groundnut all of which gained much

importance. Major part of rural population is depending on agriculture and animal husbandry.

Irrigation: Canals originating from the dam built on Chambal river in Kota district of

Rajasthan are the main source of irrigation in the south-west part of the district. The total area

irrigated by canal is 65,672 hectares and tube wells is 2,299 hectares. The economy of the

district is dominated by agriculture.

The decadal growth rate is a vital part of Census operations. This gives an overview of the

percentage of total population growth in a particular decade. The decadal population growth

rate for Sheopur is higher than the population growth rate in Madhya Pradesh.

CENSUS FINDINGS OF SHEOPUR-POPULATION AND ITS DISTRIBUTION

Sr. No. Particulars

Census Year

2001 2011

1 2 3 4

1 Area (in sq. KM.) 6606 6606

2 Number of Tehsils 3 5

3 Number of CD Blocks 3 3

4 Number of Villages 607 582

5 Total Households 96898 146043

Household size 5.8 4.7

6 Total Population 5,59,495 6,87,861

7 Decadal Population Growth (Madhya Pradesh) in % 24.26 20.23

8 Decadal Population Growth (Sheopur) in % 29.7 22.9

9 Proportion of Rural population to total population 84.2 84.4

10 Proportion of Urban population to total population 15.8 15.6

11 Sex Ratio 895 901




12 Work Participation Rate 41 40.3

13 Literacy Rate 46.4 57.4

14

Age-group wise proportion to total population

0-14 years 43.1 37.6

15-59 years 51.2 56

60+years 5.5 6.3

Age not stated 0.2 0.1

15 Scheduled Castes Population 90420 108391

Proportion of Scheduled Castes to total population 16.2 15.8

16 Scheduled Tribes Population 120482 161448

Proportion of Scheduled Tribes to total population 21.5 23.5

Source: District Census Handbook for Sheopur Year 2011




Annexure 3

Block wise detail of Sheopur District

There are three blocks in Sheopur district namely: Vijaypur, Sheopur and Karahal. The

Karahal block has the highest population of Scheduled Tribes (rural 63.08%) of the)

population among the total population of the block.

Number and percentage of scheduled castes and scheduled tribes (Rural)

population in Blocks, 2011

SR. No. Name of Block Total

Population

Total

scheduled

castes

population

Total

scheduled

tribes

population

Percentage of

scheduled

castes

population to

total

population

Percentage

of

scheduled

tribes

population

to total

population

1 0001-Vijaypur 215041 38005 44514 17.67 20.7

2 0002-Sheopur 235584 46059 30787 19.55 13.07

3 0003-Karahal 129884 7736 81926 5.96 63.08


Distribution of villages according to land use , 2011

SR. No. Name of Block Number of

inhabited

villages

Total area (in

Hectares)

Percentage of cultivable area to total

area

1 0001-Vijaypur 162 194241 20.29

2 0002-Sheopur 235 134405.09 66.87

3 0003-Karahal 119 206151.69 12.79


The Karahal block receives less rainfall. Only 12.79 % of the land in the Karahal block is

cultivable as a percentage of total area.




Distribution of workers in four major categories of Economic activity-

block wise


Number % Number % Number % Number %

Persons 215,041 97,967 50,515 51.56 37,456 38.23 534 0.55 9,462 9.66

Males 115,353 59,103 32,337 54.71 19,502 33 317 0.54 6,947 11.75

Females 99,688 38,864 18,178 46.77 17,954 46.2 217 0.56 2,515 6.47

Persons 235,584 90,082 40,952 45.46 39,837 44.22 1,058 1.17 8,235 9.14

Males 122,548 64,116 34,818 54.3 22,655 35.33 536 0.84 6,107 9.52

Females 113,036 25,966 6,134 23.62 17,182 66.17 522 2.01 2,128 8.2

Persons 129,884 55,821 12,019 21.53 34,958 62.63 950 1.7 7,894 14.14

Males 67,459 33,066 9,656 29.2 17,781 53.77 473 1.43 5,156 15.59

Females 62,425 22,755 2,363 10.38 17,177 75.49 477 2.1 2,738 12.03

Name of Block

0001-Vijaypur

Cultivators

Agricultural

Labourers

Household Industry

workers Other Workers

Category of Workers

Persons/

Males/

Females

Total

Population

Total

Workers

(Main+

marginal

Workers

)

0002- Sheopur

0003-Karahal




Annexure 4

Village Selection

Village selection was carried out following probability proportionate to size (PPS) sampling

approach. Probability proportion to size is a sampling procedure is also used by the World

Health Organization. It is generally used in studies under which the probability of a unit

being selected is proportional to the size of the ultimate unit, giving larger clusters a greater

probability of selection and smaller clusters a lower probability. In order to ensure that all

units (ex. individuals) in the population have the same probability of selection irrespective of

the size of their cluster, each of the hierarchical levels prior to the ultimate level has to be

sampled according to the size of ultimate units it contains, but the same number of units has

to be sampled from each cluster at the last hierarchical level. This method also facilitates

planning for field work because a pre-determined number of individuals are interviewed in

each unit selected, and staff can be allocated accordingly.

It is most useful when the sampling units vary considerably in size because it assures that

those in larger sites have the same probability of getting into the sample as those in smaller

sites, and vice verse. Since the estimated sample of 400 children between the age 1 and 6

years was required for the study, it was decided to draw a sample of 30 villages from the list

of 139 villages in Karahal block. Since most of the villages in this block have a reasonable

percentage of scheduled tribe population and situation of literacy and poverty is almost

homogenous, no further stratification on these criteria was done.

Serial

Number

Name of the village Serial Number Name of the village

1 Jharer 16 Nimania

2 Kalarna 17 Meharbani

3 Bhela 18 Parond

4 Bagbaaj 19 Baragwa

5 Semalda Haveli 20

Goverdha

6 Aavda 21 Goras

7 Malipura 22 Reechhi

8 Verdha 23 Panbada

9 Nimoda Madh 24 Bamori

10 Bawdi Chapa 26 Budhera

11 Vardha Khurd 27 Moraban

12 Bhoorwada 28 Morai

13 Soosbada 29 Sesaipura

14 Chakrampura 30 Piprani

15 KhiriKhiri 30 Sarari Khurd

Sampling interval rounded off -4385, random number generated-3972




Annexure 5

Data collection and identification of household

In villages Saharia households that have children in the age group 1-6 years were identified

and mapped on the village map. A central point in the village was drawn on a rough map and

two Saharia and two Non-Saharia eligible households were identified. From this centre point

the village was divided into three parts ensuring that all habitations in the confines of the

villages were covered.

For every Saharia household identified to be eligible for the study, closest Non-Saharia

household that is eligible was selected. Focused discussions held with the personnel at the

health facilities - District Hospital, Community Health Centre Karahal and at the NRC. This

was centered on quality and coverage of child health and nutrition services, and their overall

experiences. Discussions were held with the personnel at the health facilities - District

Hospital, Community Health Centre Karahal and at the NRC.

In each segment (including

the central part) effort was

done to identify one Saharia

child who is malnourished,

one Saharia normal child, one

Non-Saharia malnourished

child and one Non-Saharia

child who is normal

Centre: 2 Saharia and 2

Non-Saharia eligible

households

Segment A: 2 Saharia and 2


households

Segment B: 2 Saharia and

2 Non-Saharia eligible

households

Segment C: 2 Saharia and 2


households




Annexure-6

Balanced Diet for Adults-Sedentary /Moderate/Heavy Activity

(Number of Portions)

Type Of Work

G/Portio

n

Sedentary Moderate Heavy

Mon Woman Man Woman Man Woman

No. of portions

Cereals &

Millets

30 12.5 9 15 11 20 16

Pulses

30 2.5 2 3 2.5 4 3

Milk &

Milk Products

100 ml 3 3 3 3 3 3

Roots &

Tubers

100 2 2 2 2 2 2

Green leafy

Vegetables

100 1 1 1 1 1 1

Other

Vegetables

100 2 2 2 2 2 2

Fruits

100 1 1 1 1 1 1

Sugar

5 4 4 6 6 11 9

Fat

5 5 4 6 5 8 6

To calculate the days requirement of above mentioned food groups for an individual, multiply

grams per portion with number of portions.

Particulars Prevalence

Infants And Preschool Children (%)

Low Birth Weight 22

# Kwashiorkor/Marasmus <1

# Bitot's Spots 0.8-1.0

Iron deficiency anaemia (6-59 months) 70.0

Underweight (Weight For Age)* (<5 Years) 42.6

# Stunting (Height For Age)* (<5 Years) 48.0

# Wasting (Weight For Height)* 20.0

Childhood Overweight/Obesity

6-30

Particulars Prevalance




Adults (%)

Chronic Energy Deficiency (BMI<18.5) Among

# Rural Adults Men 33.2

Women 36.0

* Tribal Adults Men 40.0

Women 49.0

Anaemia (%)

# Women (NPNL) 75.2

# Pregnant Women 74.6

Lodine Deficiency Disorders (IDD)

Goiter (Millions) 54

Cretinism (Millions) 2.2

Still Births Due To IDD (Includes Neo Natal Deaths) 90,000

Prevalence Of Chronic Diseases Over Weight/Obesity (BMI>25) (%)

# Rural Adults Men 7.8

Women 10.9

* Tribal Adults Men 2.4

Women 3.2

Urban Adults Men 36.0

Women 40.0

Hypertension

Urban 35.0

#Rural 25.0

Men 25.0

Women 24.0

*Tribal 24.0

Men 25.0

Women 23.0

Diabetes Mellitus (%) (Year 2006)

Urban 16.0

#Rural 5.0

Coronary Heart Disease (%)

Urban 7-9

*Rural 3-5

Cancer Incidence Rate (Per 100,000)

Men 113

Women 123

*<Median-2 SD of WHO Child Growth Standards

#NNMB Rural Survery-2005-06

*NNMB Tribal Survery-2008-09

Source: Dietary Guidelines for Indians- A Manual published by National Institute of

Nutrition, Indian Council of Medical Research Hyderabad




Annexure 7

Data downloaded from MNREGA website and other websites




Block wise comparison within the district




Name Population Districts covered

Baiga 1, 31,425(23.86 %) Mandla, Shahdol, Dindori, Umariya,

Anuppur, Balaghat

Saharia 4, 17,171(75.76%) Gwalior, All districts of Chambal Division

Bharia 2,012 (0.37%) Patalkot, District Chhindwara

Source: Website of Tribal Welfare Dept, Govt of Madhya Pradesh

study of malnutrition among under-6 children of sheopur district...

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