13 January 2012

Hungama: Stirring stuff for nutrition in India

A remarkable new report has been published by the Naandi Foundation, called Hungama (a Hindi word for causing a "stir" or a "ruckus"). Undernutrition is often neglected and so we need to make more noise about it, especially when it is unresponsive to economic growth. This is what this report does. It surveys 112 districts in India.

"Of the 112 districts surveyed, 100 were selected from the bottom of a child development district index developed for UNICEF India in 2009, referred to as the 100 Focus Districts in this report. These 100 districts are located in 6 states. The best-performing district from each of these states was also selected for survey. To this set was added another set of 6 districts, 2 each from the best-performing states of the country. Having the largest sample size for a child nutrition survey since 2004, the HUNGaMA Survey captured nutrition status of 109,093 children under five years of age. Data collection took place between October 2010 and February 2011 in 3,360 villages across 9 states. Coordinated by the Naandi Foundation, the HUNGaMA survey presents underweight, stunting and wasting data at the district level (this was last done in 2004 by DLHS-2, which reported only underweight estimates). It is also the first ever effort to make the voice of over 74,000 mothers heard."

Quick read headlines for me:
  • in these districts (remember, this is not representative at the state or national level), underweight rates have declined from 53 % in 2002-4 (the LFHS 2 data) to 42% in 2011 (the Hungama data). This is a rate of about 1.4 percentage points per year, much faster than NFHS data suggest (the maroon dotted line below) and somewhat faster than the NNMB data suggest (the maroon solid line below). But has stunting declined? Unfortunately the LFHS-2 did not collect stunting data, even though Hungama did. But can we conclude that stunting (the preferred indicator of undernutrition) has also declined? Not really, because as the below data show, the NNMB recorded an increase in stunting (the solid blue line) at the same time it recorded a decline in under weight. Interestingly, the smallest decline in underweight is for the best districts in the best states (Figure 15): 35% to 32%. This is a bit surprising if only because the rates are still so high.
  • it is interesting that the stunting and underweight rates are better for the Best Districts in the Focus States than the Best Districts in the Best States (figure 1). This needs more exploration.
  • wasting rates are puzzling. These are higher for the Best Districts in the Focus States compared to the average of all Districts in Focus States. The overall wasting rates are 11-12% which is lower than the rates in the diagram above for NNMB (15%) and much lower than NFHS (19% -- a big proportionate decrease).
  • one of the big differentiating covariates of the different district groupings is whether mothers have heard of the term "malnutrition" in their local language: 8% in the 100 focal districts, 18% in the best districts from focal states and 80% in the best districts from best states. But this is not reflected in the differences in undernutrition rates in these groups (remember, the stunting and underweight rates are higher in the best districts from best states compared to the best districts from focal states)
  • lots of analyses are suggested by the data--I would like to examine how ICDS characteristics in 2004 and 2011 are correlated with changes in underweight rates
  • the 3 categories of states are a bit confusing, and simple comparisons of means might be misleading because one group consists of 100 districts and the other 2 groups consist of 6 districts each.
  • the data and the report have received serious attention from the media and the Government. I hope the research community is also active in sifting through the data
  • the effort by Naandi (and it really has been an incredible undertaking for an NGO) shows the enormous vacuum created by the lack of Government data. Despite the great work from Naandi, it remains essential to have a comparable set of snapshots from the GoI every 2-3 years.
I hope this remarkable report stirs all stakeholders into action to accelerate undernutrition reduction.


Eeshani Kandpal said...

Given the surprising trends in the "best districts", I wish the report described in greater detail what "best" really means. On what criteria were these "best performers" identified? And by how much does population vary across districts? Having said that, I completely agree with you that this survey is a commendable effort for an NGO and does a great job filling the long gaps between waves of the NFHS. Now it's up to the research community to figure out what these numbers really "mean".

(As an aside, while the state-level aggregation of NFHS-3 data exacerbated the lack of nutrition trends from India, the aggregation was done to protect the identity of individuals tested for HIV for the NFHS-3. I wish the HUNGaMA report had acknowledged the reason behind the aggregation rather than simply criticizing it.)

Marie said...

I'm very lucky to have a nutritionist Long Island by my side. I know all of my nutrition needs, and how to fulfill them. It's sad to think about others who aren't so lucky. We should do all we can to fight undernutrition.

Nutrition said...

@Marie .. you are lucky one but you can do help for others just write a posts and published it for an unlucky one people . . .

nutrition | nutrition articles

Anonymous said...
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Anonymous said...

I couldn't agree with you more. A related concern is that anthropometric indicators of nutrition in India, for both adults and children, are among the worst in the world. Furthermore, the improvement of these measures of nutrition appears to be slow relative to what might be expected in the light of international experience and of India’s recent high rates of economic growth. I have been reading a lot of Nutrition Forum online and I learned that more than three quarters of the population live in households with per capita calorie consumption below 2,100 per day in urban areas and 2,400 per day in rural areas, numbers that are often cited as minimum requirements in India.

David Franklin said...
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