Multi-state stories:Insights from the frontrunners of stunting reduction
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Transcript of Multi-state stories:Insights from the frontrunners of stunting reduction
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Presented by Phuong Hong Nguyen
International Food Policy Research Institute
Multi-state stories:
Insights from the frontrunners of
stunting reduction
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2016
38.4%
2006
Significant stunting reduction in all states in India in the last decades
2006
48%
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Stunting reduction varies by state
-3.8 -3.8 -3.8
-3.5 -3.5-3.4
-3.1-3.0
-2.9 -2.9 -2.9-2.8 -2.7
-2.6-2.5
-2.4 -2.4 -2.4-2.3 -2.2 -2.2
-2.1 -2.0-1.9
-1.7
-1.4-1.3
-1.1-0.9
-4.0
-3.5
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
-20
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
AA
RR
per
cen
tage
po
int
chan
ge
pp change AARR
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1,11,20,920
78,64,654
36,51,636
-
20,00,000
40,00,000
60,00,000
80,00,000
1,00,00,000
1,20,00,000
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9 states account for ~80% of stunted children
Number of stunted children reduced from ~76 million in 2006 to ~50 million in 2016
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In 2016, prevalence stunting is still >30% in 16 states
0
10
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40
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60St
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g p
erce
nta
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If current trend of AARR continues, only 5 states reach the WHA target in 2025
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%A
vera
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ual
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Required AARR (2016-2025) Current AARR
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What can the frontrunners, who have achieved lower rates of stunting, tell us?
48.346.3 45.3
42.039.1
27.125.7
24.3
20.1 19.7
0
10
20
30
40
50
60
% s
tun
tin
g in
20
16
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Conceptual framework for examining determinants of stunting
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Immediate determinants: Maternal nutrition status, in high versus low stunting states
Low BMI women Anemia in women of reproductive age
25.3 27 28.330.4 31.5
9.711.7
14.6 14.718.9
0
10
20
30
40
50
60
70
%
49.953.1
55.9
67.4 69.5
32.8
38 38
53.2
65.1
0
10
20
30
40
50
60
70
%
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Immediate determinants: Infant and young child feeding practices in high versus low stunting states
Early initiation of breastfeeding Adequate diet
25.228.4
33.2 34.5 34.930.7
44.4
54.7
64.3
73.3
0
10
20
30
40
50
60
70
80
%
3.45.3 6.6 7.2 7.5 5.9 5.9
10.4
21.4
30.7
0
10
20
30
40
50
60
70
80
%
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Intervention coverage: Antenatal care and IFA consumption, in high versus low stunting states
At least 4 ANC visits Consume 100+ IFA tablets
14.4
26.430.3
35.738.5
64.368.5
81.2
89 90.2
0
20
40
60
80
100
%
9.712.9
15.3 17.3
23.6
13.4
42.6
64.067.1 67.4
0
20
40
60
80
100
%
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Intervention coverage: Immunization and vitamin A supplementation for children, in high versus low stunting states
Fully immunized Vitamin A supplementation
51.153.6 54.8
61.7 61.9
54.5
69.7
82.1
88.4 89.1
0
20
40
60
80
100
%
39.5 39.6
52.9
60.4 62.3 62.8
68.370.6
74.4
89.5
0
20
40
60
80
100
%
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Underlying determinants: Women’s education and age at marriage, in high versus low stunting states
Women with 10y+ education Married before 18y of age
22.8 23.225.1
28.7
32.9
23.4
50.9
55.158.2
72.2
0
20
40
60
80
%
21.2
30
35.438 39.1
7.6 7.69.8
15.7
32.2
0
20
40
60
80
%
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Underlying determinants: Water and sanitation, in high versus low stunting states
Improved drinking water Improved sanitation
24.4 25.2
33.7 35.0
45.0
52.2
61.3
78.381.5
98.1
0
20
40
60
80
100
%
77.8
84.7 85.5
96.4 98.2
87.390.6
94.396.3 99.1
0
20
40
60
80
100
%
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Regression analysis comparing very high burden (stunting >40%) and low burden districts (stunting<20%) also provides some insights on important determinants
Asset score13%
Women with 10+ years school
17%
Adequate diet5%
ANC 4+ times4%
Open defecation density
7%
Married at 18+ years5%
Household size8%
ST/SC population3%
Unexplained38%
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Differences between high and low stunting states/districts are attributable to factors related to immediate and underlying determinants, and intervention coverage
▪Determinants
o Maternal nutrition
o Infant feeding
o Sanitation
o Women’s education
o Age at marriage
▪ Intervention coverage
o ANC
o IFA
o Others (not shown)
Changing malnutrition outcomes requires an investment
in changing intervention coverage and subsequently in
changing determinants.
The POSHAN Policy Notes for each state can help with
diagnostic assessments
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Looking forward: Stories of Change in nutrition for different successful states in India
Initial SoC studies will be done in 5
states: Odisha, Arunachal Pradesh,
Tamil Nadu, Gujarat, Chhattisgarh.
Stories of Change research for Odisha, available in: Menon et al., Nourishing Millions, 2016; Kohli et al., Global Food Security, 2017
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Closing thoughts
➢ Malnutrition burden in India remains high despite some progress
➢ Tremendous inter-state and inter-district variability
➢ Inter-district and inter-state differences in stunting are not explained by any single
factor, but rather by a set of maternal, economic, health, hygiene and demographic
factors.
➢ Most importantly, many success stories across India, which are important to learn
from.
➢ POSHAN state Policy Notes help policy community examine state of nutrition
outcomes, immediate and underlying determinants and intervention coverage:
diagnose and identify challenges that need attention.
➢ Analysis of unit-level data, when available, from NFHS-4, and Stories of Change
studies at the state-level will help to support India’s nutrition policy community