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Sattvika Ashok, Rasmi Avula, S.K. Singh, Rakesh Sarwal, Neena Bhatia, Robert Johnston, William Joe, Purnima Menon, Phuong Hong Nguyen
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No. 53 | SEPTEMBER 2021
State Nutrition Profile: Sikkim
ABOUT THIS DATA NOTE
Figure 1. Trends in undernutrition outcomes
2005-2006, 2015-2016, 2019-2020
2005-2006 2015-2016 2019-2020 India average
10
2
8
2
NA 392922 121614 587 201413 575656 1166 593542 622441
0
20
40
60
80
100
Low birth weightStunting WastingSevere wastingUnderweight Anemia Underweight Anemia
(non-pregnant)
Anemia
(pregnant)
%
Undernutrition among children (<5y)Undernutrition among women (15-49y)
SIKKIM
3
This Data Notedescribes the trends for a set of key
nutrition and health outcomes, determinants, and
coverage of interventions. The findings here are based
on data from the National Family Health Survey (NFHS)
3 (2005-2006), 4 (2015-2016), and 5 (2019-2020). In
addition to standard prevalence-based analyses, this
Data Noteincludes headcount-based analyses aligned
to the POSHAN Abhiyaanmonitoring framework and
uses data from NFHS-5 to provide evidence that helps
identify priority districts and number of districts in the
state with public health concern as per the WHO
guidelines.
1
The Data Noteincludes a color-coded
dashboard to compare the coverage of nutrition
interventions across all the districts in the state. It
concludes with key takeaways for children, women, and
men and identifies areas where the state has potential
to improve.
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state factsheets (2019-2020).
Note: Adult nutrition outcomes are based on the woman dataset, while child nutrition outcomes are based on all child data.
1
WHO. Nutrition Landscape Information System (NLiS). Help Topic: Malnutrition in children. Stunting, wasting, overweight and underweight.
(https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=391&lang=EN).
2
In NFHS-3, 40.6% of data was missing, while 1.7% of data was missing in
NFHS-4.
3
NA refers to the unavailability of data for a particular indicator in the specified NFHS round. No. of districts with public health concern
1
: 4 of 4
Map 1 & 2. Number of stunted & anemic children <5y , 2019-2020
Source: IFPRI estimates -The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected population for each district
in 2019. Prevalence estimates were obtained from NFHS-5 (2019-2020; all child data) and projected population for 2019 was estimated using Census 2011.
1
Public health concern is defined as ≥20% for stunting, ≥40% for anemia, ≥10% for wasting, and ≥2% for severe wasting (WHO 2011).
2
The total number of
children <5 years is 48,472.
Map 1. Stunting
Map 3. Wasting
Map 2. Anemia
Highest burden districts
1East District3,800
2West District2,992
3South District 2,906
4North District 1,122
Highest burden districts
1East District3,053
2West District2,505
3South District938
4North District159
Highest burden districts
1East District9,551
2West District7,157
3South District 5,948
4North District 1,696
No. of districts with public health concern
1
: 3 of 4
No. of districts with public health concern
1
: 2 of 4
No. of districts with public health concern
1
: 4 of 4
Number of stunted
children
2
= 10,820
Number of wasted
children
2
= 6,655
Number of anemic
children
2
= 24,352
Map 3 & 4. Number of wasted children <5y, 2019-2020
Map 4. Severe Wasting
Number of severely wasted
children
2
= 3,216
Highest burden districts
1West District1,449
2East District1,196
3South District469
4North District102
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure Map 5 & 6. Number of underweight children (<5y)
& women (15-49y), 2019-2020
Source: IFPRI estimates -The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected population for each district
in 2019. Prevalence estimates were obtained from NFHS-5 (2019-2020; all child/woman data) and projected population for 2019 was estimated using Census
2011.
1
Public health concern is defined as≥20% for underweight (children), ≥10% for underweight (women), ≥40% for anemia among non-pregnant women, and
≥40% for anemia among pregnant women (WHO 2011).
2
The total number of children <5 years is 48,472, pregnant women 15-49 years is 9,237, and non-
pregnant women 15-49 years is 19,2013.
3
Gray area in Map 8 indicates districts for which data are not available.
Map 6. Underweight women
Map 7. Anemia among non-pregnant women Map 8. Anemia among pregnant women
3
Highest burden districts
1East District7,410
2South District 2,211
3West District1,322
4North District438
Highest burden districts
1North District151
Highest burden districts
1East District41,667
2South District 19,177
3West District18,778
4North District 4,765
No. of districts with public health concern
1
: 0 of 4
No. of districts with public health concern
1
: 3 of 4 No. of districts with public health concern
1
: 0 of 4
Number of underweight
women
2
= 11,381
Number of non-pregnant
anemic women
2
= 84,387
Number of pregnant
anemic women
2
=
151
Map 5. Underweight children
Highest burden districts
1East District2,775
2West District2,291
3South District844
4North District540
No. of districts with public health concern
1
: 0 of 4
Number of underweight
children
2
= 6,450
Map 7 & 8. Number of anemic women (15-49y), 2019-2020
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure Category Outcomes
Worst performing
districts (pp)
Best performing
districts (pp)
Highest burden
districts
(thousands)
3
No of
districts with
public health
concern
4
(total=4)
Difference between
(2019-2020) & (2015-
2016)
2
Difference between
(2019-2020) & (2015-
2016)
2019-20202019-2020
Children
<5 years
Overweight/
obesity
North: +1.6
South: +1.5
West: -9.4
East: -0.5
South: 2
East: 1
1
Women
(15-49 years)
Overweight/
obesity
North: +18.7
South: +12.5
Not applicable
5
East: 36
South: 16
4
High blood
pressure
South: +20.0
West: +15.6
Not applicable East: 25
South: 17
4
High blood
sugar
South: +1.3
North: +0.4
West: -3.5 East: 7
South: 3
0
Men
(15-54 years)
Overweight
/obesity
Data not available at district-level
High blood
pressure
North: +14.1
West: +11.6
East: -1.1 East: 29
South: 19
4
High blood
sugar
Not applicable West: -3.3
South: -3.1
East: 6
South: 3
0
Figure 2. Trends in overweight/obesity & NCDs
1
2005-2006, 2015-2016, 2019-2020
Table 1. Overweight/obesity & NCDs
1
at district-level
2015-2016, 2019-2020
2005-2006 2015-2016 2019-2020 India average
1411
10 152735 NA
*
1930 NA76 63736 NA1139 NA108
0
20
40
60
80
100
Overweight/
obesity
Overweight/
obesity
High blood
pressure
High blood
sugar
Overweight/
obesity
High blood
pressure
High blood
sugar
%
Children (<5y)Women (15-49y)Men (15-54y)
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets (2019-2020).pp: percentage points.
Note: Adult nutrition outcomes are based on the woman/man dataset, while child nutrition outcomes are based on all child data.
*
NA refers to the unavailability of data for a particular indicator in the specified NFHS round.
1
NCDs : non-communicable diseases.
2
The difference is calculated only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts
are comparable between 2015-2016 and 2019-2020.
3
Burden: The headcount was calculated as the product of the overweight/obesity and NCDs prevalence and the total eligible projected population for each district
in 2019. Prevalence estimates were obtained from NFHS-5 (2019-2020) and projected population for 2019 was estimated using Census2011.
4
Public health concern is defined as prevalence ≥15% for overweight/obesity (children), ≥20% for overweight/obesity (women andmen), ≥20% high blood
pressure (women and men), and ≥20% high sugar (women and men). Source: WHO (2011).
5
Prevalence did not increase or decrease in any of the districts. Category
Immediate
determinants
Worst performing
districts (pp)
Best performing
districts (pp)
Top coverage
districts (%)
2
Difference between
(2019-2020) & (2015-2016)
1
Difference between
(2019-2020) & (2015-2016)
2019-2020
IYCF
practices
Early initiation of
breastfeeding
South: -50.9
East: -38.2
Not applicable
3
West: 56.2
South: 28.2
Exclusive
breastfeeding
Data not available
Timely introduction of
complementary foods
0
Data not available
Adequate diet
0
South: -1.5
South: +10.2
North: +5.3
West: 28.4
North: 25.3
Maternal
determinants
Women with BMI<18.5
kg/m2
0
East: +2.8
North: +1.6
South: -1.3
West: -0.3
East: 7.7
South: 4.6
Consumed IFA 100+
days
West: -18.2
West: +9.0
East: +5.6
North: 74.0
South: 71.3
Diseases
Diarrhea in the last two
weeks
0
South: +4.5
North: +4.4
Not applicable
South: 4.5
West: 3.3
ARI in the last two
weeks
0
West: +1.5
East: +0.2
North: -0.3
East: 0.5
South: 0
Figure 3. Trends in immediate determinants (%)
2005-2006, 2015-2016, 2019-2020
Table 2. Immediate determinants at district-level
2015-2016, 2019-2020
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets (2019-2020). pp: percentage points.
Note: Immediate determinants are based on the last child data; data on continued breastfeeding at 2 years, egg and/or flesh foods consumption, sweet beverage
consumption, and bottle feeding of infants not available in NFHS-5 factsheets (2019-20)/state report.
0
Indicator definition differs slightly between NFHS-4 and NFHS-5.
1
The difference is calculated only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts are comparable between 2015-2016
and 2019-2020.
2
For all indicators, top coverage districts refer to the districts with the highest prevalence in immediate determinants, except for women with a BMI of 18.5 kg/m2,
diarrhea in the last two weeks, and ARI in the last two weeks, for which it refers to the districts with the lowest prevalence in coverage.
3
Prevalence did not increase or decrease in any of the districts. Category
Underlying
determinants
Worst performing
districts (pp)
Best performing
districts (pp)
Top coverage
districts (%)
2
Difference between
(2019-2020) & (2015-2016)
1
Difference between
(2019-2020) & (2015-2016)
2019-2020
Maternal
determinants
Women who are literate
0
West: -2.7
North: -2.6
South: +4.9
East: +4.6
South: 90.5
East: 90.1
Women with ≥10 years
education
0
Not applicable
3
West: +18.9
South: +16.5
East: 53.2
South: 45.7
Girls 20-24 years married
before age of 18 years
0
Not applicable
East: -30.4
South: -26.5
East: 1.7
South: 8.7
Women 15-19 years with
child or pregnant
South: +6.7
North: +1.4
East: -2.1
East: 1.7
West: 2.5
Household
determinants
HHs with improved
drinking water source
0
South: -5.4
East: -4.2
Not applicable
North: 94.7
East: 93.6
HHs with improved
sanitation facility
0
West: -4.6
North: -2.8
East: +7.8
South: 91.7
West: 88.9
HHs with electricity
0
West: -1.2
North, South: -0.4
East: +0.9
South: 99.6
East: 99.4
Figure 4. Trends in underlying determinants (%)
2005-2006, 2015-2016, 2019-2020
Table 3. Underlying determinants at district-level
2015-2016, 2019-2020
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets and state reports (2019-2020).
Note: Underlying determinants are based on the last child data; safe disposal of feces not available in NFHS-5 factsheets (2019-20)/state report and data on HHs
with hand washing facility not available in NFHS-3 (2005-06) and NFHS-5 factsheets (2019-20)/state report. Data on open defecation and HHs with BPL card for
2019-2020 are taken from NFHS-5 state reports.
0
Indicator definition differs slightly between NFHS-4 and NFHS-5.
1
The difference is calculated only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts are comparable between 2015-16 and
2019-20.
2
For all indicators, top coverage districts refer to the districts with the highest prevalence in underlying determinants, exceptfor girls 20-24 years married
before age of 18 years and women 15-19 years with child or pregnantfor which it refers to the districts with the lowest prevalence in coverage.
3
Prevalence did not increase or decrease in any of the districts. Figure 5. Trends in interventions across the first 1000 days (%)
2005-2006, 2015-2016, 2019-2020
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016) & NFHS-5 state factsheets and state reports (2019-2020).
0
Indicator comparable between NFHS-3 and NFHS-4 but differs slightly from NFHS-5.
Note 1: Interventions’ coverage is based on the last child data.
Note 2: The following information is not available in the NFHS-5 factsheets and state reports (2019-20): receipt of at least oneANC visit, birth preparedness
counselling, malaria prevention and food supplementation (6-35m). Information on use of bed nets during pregnancy is not available in NFHS-3 data (2006).
Note 3: Data on food supplementation and health and nutrition education during pregnancy and post-natal care, and weight measurement during childhood and
counselling on child growth for 2019-2020 are taken from NFHS-5 state reports.
Note 4: Refer to district dashboard for the inter-district variability in the coverage of interventions. Intervention coverage at district level, 2019-2020
Source: NFHS
-
5 district factsheets and state reports (2019
-
20).
Note 1: The following information is not available in the NFHS
-
5 factsheets and state reports (2019
-
20): (1) Information on pre
conception and pregnancy
-
related indicators including demand for FP satisfied,
receipt of at least one ANC visit, weighing, birth preparedness and breastfeeding counselling, counselling on keeping baby wa
rm,
cord care counselling, food supplementation, health and nutrition education and
malaria prevention; (2) Lactation
-
related indicators including, food supplementation and health and nutrition education; and (3)
early childhood
-
related indicators including pediatric IFA, deworming, food
supplementation (6
-
35m), weighing and counselling on child growth. Information on use of bed nets during pregnancy not available
in NFHS
-
3 data (2005
-
2006).
Note 2: Food supplementation during early childhood is for children aged 6
-
35 months; counselling on child growth during early c
hildhood is conducted after taking weight measurement. District name
Demand for FP
satisfied
Iodized salt
Any ANC visits
ANC first trimester
≥4 ANC
Received MCP card
Received IFA
tab/syrup
Tetanus injection
Deworming
Weighing
Birth preparedness
counselling
Breastfeeding
counselling
Counselling on
keeping baby warm
Cord care counselling
Food supplementation
Health & nutrition
education
Malaria prevention-
use of bed nets
Institutional birth
Financial assistance
(JSY)
Skilled birth attendant
Postnatal care for
mothers
Postnatal care for
babies
Food supplementation
Health & nutrition
education
Full immunization
Vitamin A
Paediatric IFA
Deworming
Care seeking for ARIORS during diarrheaZinc during diarrhea
Food supplementation
(6-35 months)
Weighing
Counselling on child
growth
SIKKIM98.3 63.758.494.694.492.029.694.75.896.569.366.2 80.687.5 59.564.250.0
East District97.7 53.443.891.993.390.331.691.84.294.265.859.291.2 63.4
North District99.0 66.259.495.595.292.532.597.314.698.571.372.0 90.890.1
South District99.4 78.184.599.496.792.335.097.45.699.483.181.1 86.488.4
West District98.1 75.870.496.494.595.917.799.37.599.363.667.8 96.972.2
<25%50-<75% >75%
Pre-
pregnancy
PregnancyDelivery & postnatalEarly childhood
Source: NFHS-5 factsheets (2019)Not Available25-<50% Category Interventions
Worst performing
districts (pp)
Best performing
districts (pp)
Top coverage
districts (%)
Difference between
(2019-2020) & (2015-2016)
1
Difference between
(2019-2020) & (2015-2016)
2019-2020
ANC first trimester
East: -16.4
North: -14.7
Not applicable
2
South: 78.1
West: 75.8
Pregnancy
≥4 ANC visits
East: -24.3
West: -14.5
Not applicable
South: 84.5
West: 70.4
Received MCP Card
East: -6.3
North: -3.1
South: +2.2
West: +0.5
South: 99.4
West: 96.4
Tetanus injection
South: -7.7
East: -5.0
Not applicable
West: 95.9
North: 92.5
Delivery and
post-natal
Institutional birth
0
East: -1.5
South: -0.9
West: +3.3
North: +0.7
West: 95.9
North: 92.5
Skilled birth attendant
0
East: -2.3
North: -0.8
West: +2.0
West: 99.3
South: 97.4
Postnatal care for
mothers
North: -13.4
West: -10.1
South: +0.4
South: 83.1
North: 71.3
Postnatal care for
babies
0
Not applicable
South: +57.0
North: +54.9
South: 81.1
North: 72.0
Early
childhood
Full immunization
South: -5.2West: +17.5
North: +0.9
West: 96.9
North: 90.8
Vitamin A
supplementation
0
West: -3.0
East: +11.0
South: +5.6
East: 91.2
North: 90.1
Care seeking for ARI
0
East: -1.2Data not available East: 63.4
ORS treatment during
diarrhea
0
Data not available
Zinc treatment during
diarrhea
0
Data not available
Table 4. Intervention coverage at district-level
2015-2016, 2019-2020
Key takeaways
Children: Stunting prevalence declined by 10 percentage points (pp) between 2006 to 2016 and by 7pp between
2016 to 2020. Underweight declined by 6pp between 2006 and 2016 and by 1pp between 2016 and 2020. Anemia
declined by 1pp between 2006 and 2016 and did not change between 2016 and 2020.
Women: Underweight declined by 5pp between 2006 and 2016 and remained constant between 2016 and 2020.
Anemia among non-pregnant and pregnant women declined by 24pp and 36pp, respectively, between 2006 and 2016.
But it increased by 7pp and 17pp among non-pregnant and pregnant women, respectively, between 2016 and 2020.
Overweight/obesity increased by 12pp between 2006 and 2016 and by 8pp between 2016 and 2020.
Men: Overweight/obesity increased by 31pp between 2006 and 2016 and decreased by 1pp between 2016 and 2020.
Attention is needed to improve (%s in 2020):
• Outcomes: Stunting (22%) and anemia in children (56%); anemia in non-pregnant (42%) and pregnant (41%)
women
• Immediate determinants:Early initiation of breastfeeding (33%); exclusive breastfeeding (28%); adequate diet
(25%); 100+ IFA (55%)
• Underlying determinants:Women with 10 years education (49%)
• Coverage of interventions:4 ANC visits (58%);food supplementation (46-53%); health and nutrition
education for women (42-49%); postnatal care for mothers (69%) and babies (66%); ORS (64%) and zinc (50%)
during diarrhea; growth monitoring of children (62%)
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets (2019-2020). pp: percentage points
Note: Interventions’ coverage are based on the last child data.
0
Indicator definition differs slightly between NFHS-4 and NFHS-5.
1
The difference is calculated
only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts are comparable between 2015-16 and 2019-20.
2
Prevalence did
not increase or decrease in any of the districts. Indicator definition
Nutrition outcomesDefinition
Low birth weight
Percentage of live births in the five years preceding the survey with a reported birth weight less than 2.5 kg, based on
either a written record or the mother's recall
Stunting among children Percentage of children aged 0-59 months who are stunted i.e., height-for-age z score < -2SD
Wasting among children Percentage of children aged 0-59 months who are wasted i.e., weight-for-height z score < -2SD
Severe wasting among children Percentage of children aged 0-59 months who are wasted i.e., weight-for-height z score < -3SD
Underweight childrenPercentage of children aged 0-59 months who are underweight i.e., weight-for-age z score < -2SD
Anemia among children Percentage of children aged 6-59 months who are anemic i.e., (Hb <11.0 g/dl)
Underweight womenPercentage of women aged 15-49 whose Body Mass Index (BMI) is below normal (BMI <18.5 kg/m2)
Anemia among non-pregnant
women
Percentage of non-pregnant women aged 15-49 who are anemic (<12.0 g/dl)
Anemia among pregnant women Percentage of pregnant women aged 15-49 who are anemic (<11.0 g/dl)
Overweight/obesity -children Percentage of children aged 0-59 months who are overweight i.e., weight-for-height z score > 2SD
Overweight/obesity -women Percentage of men aged 15-54 who are overweight or obese (BMI ≥25.0 kg/m2)
Overweight/obesity -men Percentage of men aged 15-54 who are overweight or obese (BMI ≥25.0 kg/m2)
High blood pressure among women^Percentage of women aged 15-49 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High blood pressure among men^ Percentage of men aged 15-54 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High sugar level among women^ Percentage of women aged 15-49 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High sugar level among men^ Percentage of men aged 15-54 with high blood sugar levels (141-160 mg/dl)
Immediate determinants
Early initiation of breastfeeding
Percentage of children under aged 3 years breastfed within one hour of birth for the last child born in the 3 years
before the survey
Exclusive breastfeeding Percentage of youngest children under age 6 months living with mother who were exclusively breastfed
Timely introduction of
complementary foods
0
1
Percentage of youngest children aged 6-8 months living with mother who received solid or semi-solid food during the
previous day;
2
Percentage of youngest children aged 6-8 months living with mother who received solid or semi-solid
food and breastmilk
Continued breastfeeding at 2 years
$
Percentage of youngest children 12–23 months of age who were fed breast milk during the previous day
Adequate diet
Percentage of youngest children 6–23 months of age who consumed a minimum acceptable diet during the previous
day
Eggs and/or flesh foods
consumption
$
Percentage of youngest children 6–23 months of age who consumed egg and/or flesh food during the previous day
Sweet beverage
$
Percentage of youngest children 6–23 months of age who consumed a sweet beverage during the previous day
Bottle feeding for infants
$
Percentage of youngest children 0–23 months of age who were fed from a bottle with a nipple during the previous day
Women with body mass index
<18.5 kg/m
2 0
1
Percentage of women aged 15-49 with a youngest child < 5 years who have BMI below normal (BMI <18.5 kg/m2) ;
2
Percentage of women aged 15-49 whose BMI is below normal (BMI <18.5 kg/m
2
)
Consumed IFA 100+ days
Percentage of mothers aged 15-49 who consumed iron folic acid for 100 days or more during the last pregnancy in
last five years preceding the survey
Diarrhea in the last two weeks
0
1
Percentage of youngest children under age five who had diarrhea in the two weeks preceding the survey;
2
Percentage of children under age 5 who had diarrhea in the 2 weeks preceding the survey
ARI in the last two weeks
0
1
Percentage of youngest children under age five who had symptoms of acute respiratory infection (ARI) in the two
weeks preceding the survey;
2
Percentage of children under age five who had symptoms of acute respiratory
infection (ARI) in the two weeks preceding the survey
Underlying determinants
Women who are literate
0
1
Percentage of women aged 15-49 with a birth in five years preceding the survey who are literate i.e., those who
completed standard 6 or higher and can read a whole sentence;
2
Percentage of women aged 15-49 who are literate
i.e., those who completed standard 9 or higher and can read a whole sentence or part of a sentence.
Women with ≥10 years education
0
1
Percentage of women aged 15-49 with a birth in five years preceding the survey with 10 or more years of schooling;
2
Percentage of women aged 15-49 with 10 or more years of schooling
Girls 20-24 years married before
age of 18 years
0
1
Percentage of women aged 20-24 years with a birth in five years preceding the survey who were married before age
18 years;
2
Percentage of women aged 20-24 years who were married before age 18 years
Women 15-19 years with child or
pregnant
Percentage of currently married women aged 15-49 who had their first birth before age 20 years and in the five years
preceding the survey
HHs with improved drinking water
source
0
1
Percentage of youngest children under age 5 living in household that use an improved source of drinking water;
2
Population living in households that use an improved sanitation facility
HHs with improved sanitation
facility
0
1
Percentage of youngest children under age 5 living in household that uses improved toilet facility;
2
Population living
in households that use an improved sanitation facility
HHs with hand washing facility
^$
Percentage of youngest children under age 5 living in household that had soap and water for washing hands
Open defecation
@
Percentage of youngest children under age 5 living in household that has no toilet facility/defecates in open
Safe disposal of feces
$
Percentage of youngest children living with mother whose stools were disposed of safely
HHs with BPL card
@
Percentage of youngest children under age 5 living in households with BPL card
HHs with electricity
0
1
Percentage of youngest children under age 5 living in household that has electricity;
2
Population living in households
with electricity
^
Indicator not available in NFHS-3.
$
Indicator not available in NFHS-5 factsheets/state reports
0
Indicator comparable between NFHS-3 and NFHS-4
but differs slightly from NFHS-5.
@
Indicator not available in NFHS-5 factsheets but available in NFHS-5 states reports.
1
Definition per NFHS-3/NFHS-4.
2
Definition as per NFHS-5 factsheet. Indicator definition
InterventionsDefinition
Demand for FP satisfied
@
Percentage of currently married women aged 15-49 with demand for family planning satisfied by modern methods
Iodized salt
01
Percentage of women aged 15-49 living in HHs that use iodized salt;
2
Percentage of households using iodized salt
Any ANC visits
$
Percentage of women aged 15-49 with a live birth in the five years who received at least one ANC for the last birth
ANC first trimesterPercentage of women (15-49 years of age) attended by any provider during the first trimester of pregnancy that led to
the birth of the youngest child in the last 2 years
≥ 4ANCPercentage of mothers aged 15-49 who had at least 4 antenatal care visits for last birth in the 5 years before the
survey
Received MCP cardPercentage of mothers who registered last pregnancy in the 5 years preceding the survey for which she received a
Mother and Child Protection (MCP) card
Received IFA tab/syrup
@
Percentage of women who received IFA (given or purchased) tablets during the pregnancy for their most recent live
birth in the 5 years preceding the survey
Tetanus injectionPercentage of women whose last birth was protected against neonatal tetanus (for last birth in the five years
preceding the survey )
Deworming-pregnancy
@
Percentage of women who took an intestinal parasite drug during the pregnancy for their most recent live birth in the
5 years preceding the survey
Weighing-pregnancy
@
Percentage of women aged 15-49 with a live birth in the five years preceding the survey who were weighed during
ANC for the last birth
Birth preparedness counselling
$
Percentage of women who had at least one contact with a health worker in the three months preceding the survey
and were counselled on birth preparedness; calculated among women aged 15-49 who gave birth in the five years
preceding the survey
Breastfeeding counselling
@
Percentage of women who met with a community health worker in the last three months of pregnancy and received
advice on breastfeeding (for the last pregnancy in the five years preceding the survey)
Counselling on keeping baby
warm
@
Percentage of women who met with a community health worker in the last three months of pregnancy and received
advice on keeping the baby warm for their most recent live birth in the five years preceding the survey
Cord care counselling
^@
Percentage of women who met with a community health worker in the last three months of pregnancy and received
advice on cord care for their most recent live birth in the five years preceding the survey
Food supplementation -
pregnancy
@
1
Percentage of youngest children under age 5 whose mother received supplementary food from AWC during
pregnancy;
3
Among children under 6 years, percentage whose mother received specific benefits from AWC during
pregnancy: supplementary food
Health & nutrition education –
pregnancy
@
1
Percentage of mothers who received health and nutrition education from an Anganwadi Centre (AWC) during last
pregnancy in the five years preceding the survey;
3
Among children under 6 years, percentage whose mother received
specific benefits from AWC during pregnancy: health and nutrition education
Malaria prevention-use of bed
nets
^$
Percentage of women who used mosquito net during the pregnancy for their most recent live birth in the 5 years
preceding the survey
Institutional birth
01
Percentage of women aged 15-49 who gave birth in health/institutional facility for their most recent live birth in the 5
years preceding the survey;
2
Percentage of live births to women aged 15-49 in the five years preceding the survey
that took place in a health/institutional facility
Financial assistance (JSY)
@
Percentage of women who received financial assistance under JSY for their most recent live birth that took place in
institutional facility in the 5 years preceding the survey
Skilled birth attendant
01
Percentage of women whose last delivery was attended by a skilled health personnel for their most recent live birth
in the 5 years preceding the survey;
2
Percentage of births attended by skilled health personnel for births in the 5
years before the survey
Postnatal care for mothers Percentage of mothers who received postnatal care from a doctor/nurse/LHV/ANM/midwife/other health personnel
within 2 days of delivery for their most recent live birth in the five years preceding the survey
Postnatal care for babies Percentage of children who received postnatal care from a doctor /nurse /LHV /ANM /midwife /other health personnel
within 2 days of delivery for last birth in the 5 years before the survey
Food supplementation –postnatal
@ 1
Percentage of youngest children under age 5 whose mother received supplementary food from AWC while
breastfeeding;
3
Among children under 6 years, percentage whose mother received specific benefits from AWC while
breastfeeding: supplementary food
Health & nutrition education –
postnatal
@
1
Percentage of youngest children under age 5 whose mother received health check-ups from AWC while
breastfeeding;
3
Among children under 6 years, percentage whose mother received specific benefits from AWC while
breastfeeding: health and nutrition education
Full immunization
01
Percentage of youngest living children aged 12-23 months fully vaccinated based on information from either
vaccination card or mother's recall;
2
Percentage of children aged 12-23 months fully vaccinated based on information
from either vaccination card or mother's recall
Vitamin A –early childhood
01
Percentage of youngest children aged 6-59 months who received Vitamin A supplementation in the last 6 months
preceding the survey; 2 Percentage of children aged 9-35 months who received a vitamin A dose in the last 6 months
Pediatric IFA
0@
Percentage of youngest children aged 6-59 months who received iron supplements in the past 7 days preceding the
survey
Deworming –early childhood
0@
Percentage of youngest children aged 6-59 months who received deworming tablets in the last 6 months preceding
the survey
Care seeking for ARI
01
Percentage of youngest children under age 5 years with fever or symptoms of ARI in the 2 weeks preceding the
survey taken to a health facility or health provider;
2
Percentage of children under age 5 years with fever or symptoms
of ARI in the 2 weeks preceding the survey taken to a health facility or health provider
ORS during diarrhea
01
Percentage of youngest children under age 5 years with diarrhea in the 2 weeks preceding the survey who received
oral rehydration salts (ORS); 2Percentage of children under age 5 years with diarrhea in the 2 weeks preceding the
survey who ORS
Zinc during diarrhea
01
Percentage of youngest children under age 5 years with diarrhea in the 2 weeks preceding the survey who
received zinc;
2
Percentage of children under age 5 years with diarrhea in the 2 weeks preceding the survey who
received zinc
Food supplementation (children 6-
35 months)
$
Percentage of youngest children aged 6-35 months who received food supplements from AWC in the 12 months
preceding the survey
Weighing –early childhood
@
Percentage of youngest children under age 5 who were weighed at AWC in the 12 months preceding the survey
Counselling on child growth
@
Percentage of youngest children under age 5 whose mother received counselling from an AWC after child was
weighed in the 12 months preceding the survey
^
Indicator not available in NFHS-3.
$
Indicator not available in NFHS-5 factsheets/state reports.
@
Indicator not available in NFHS-5 factsheets but available in
NFHS-5 states reports.
0
Indicator comparable between NFHS-3 and NFHS-4 but differs slightly from NFHS-5.
1
Definition per NFHS-3/NFHS-4.
2
Definition as per NFHS-5 factsheet.
3
Definition as per NFHS-5 state reports. ABOUT POSHAN
Partnerships and Opportunities to
Strengthen and Harmonize Actions
for Nutrition in India (POSHAN) is a
multi-year initiative that aims to
support the use of data and evidence
in decision-making for nutrition in
India. It is supported by the Bill &
Melinda Gates Foundation and led by
IFPRI in India.
http://poshan.ifpri.info/
ABOUT DATA NOTES
POSHAN Data Notes focus on data
visualization to highlight geographic
and/or thematic issues related to
nutrition in India. They draw on
multiple sources of publically
available data.
CONTACT US
Email: IFPRI-POSHAN@cgiar.org
IFPRI-NEW DELHI
INTERNATIONAL FOOD POLICY
RESEARCH INSTITUTE
NASC Complex, CG Block,
Dev Prakash Shastri Road,
Pusa, New Delhi 110012, India
T+91.11.66166565
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INTERNATIONAL FOOD POLICY
RESEARCH INSTITUTE
1201 Eye Street, NW,
Washington, DC 20005 USA
T. +1.202.862.5600
F. +1.202.467.4439
Skype: IFPRIhomeoffice
ifpri@cgiar.org
www.ifpri.org
This publication has been prepared by
POSHAN. It has not been peer
reviewed. Any opinions stated herein
are those of the author(s) and do not
necessarily reflect the policies of the
International Food Policy Research
Institute.
Copyright © 2021 International Food
Policy Research Institute. All rights
reserved. For permission to republish,
contact ifpri-copyright@cgiar.org.
AUTHORS
Sattvika Ashok, Research Analyst, IFPRI
Rasmi Avula, Research Fellow, IFPRI
S.K. Singh, Professor, IIPS
Rakesh Sarwal, Additional Secretary, NITI Aayog
Neena Bhatia, Senior Specialist, NITI Aayog
Robert Johnston, Nutrition Specialist UNICEF
William Joe, Assistant Professor, IEG
Purnima Menon, Senior Research Fellow, IFPRI
Phuong Hong Nguyen, Senior Research Fellow, IFPRI
Disclaimer: The maps used in this Data Note are based on the districts in NFHS-5
factsheets/reports . The boundaries shown do not imply any official endorsement or
acceptance by IFPRI.
SUGGESTED CITATION
Ashok, A., R. Avula, S.K. Singh, R. Sarwal, N. Bhatia, R.
Johnston, W. Joe, P. Menon, and P.H. Nguyen. 2021.
State Nutrition Profile Sikkim. POSHAN Data Note 53. New
Delhi, India: International Food Policy Research Institute.
ACKNOWLEDGEMENTS
Financial support for this Data Note was provided by the
Bill & Melinda Gates Foundation through POSHAN, led by
the International Food Policy Research Institute. The
funder played no role in decisions about the scope of the
analysis or the contents of the Note.
We thank Long Quynh Khuong(Independent Researcher)
for creating the maps, Nishmeet Singh (IFPRI) and Anjali
Pant (IFPRI) for working with the dataset and Julie
Ghostlaw (IFPRI) & Abhilasha Vaid (Consultant) for
editing and reviewing the Note.
PARTNERS
Institute of Economic Growth (IEG)
International Institute for Population Science (IIPS)
NITI Aayog
UNICEF
State Nutrition Profile: Sikkim
ABOUT THIS DATA NOTE
Figure 1. Trends in undernutrition outcomes
2005-2006, 2015-2016, 2019-2020
2005-2006 2015-2016 2019-2020 India average
10
2
8
2
NA 392922 121614 587 201413 575656 1166 593542 622441
0
20
40
60
80
100
Low birth weightStunting WastingSevere wastingUnderweight Anemia Underweight Anemia
(non-pregnant)
Anemia
(pregnant)
%
Undernutrition among children (<5y)Undernutrition among women (15-49y)
SIKKIM
3
This Data Notedescribes the trends for a set of key
nutrition and health outcomes, determinants, and
coverage of interventions. The findings here are based
on data from the National Family Health Survey (NFHS)
3 (2005-2006), 4 (2015-2016), and 5 (2019-2020). In
addition to standard prevalence-based analyses, this
Data Noteincludes headcount-based analyses aligned
to the POSHAN Abhiyaanmonitoring framework and
uses data from NFHS-5 to provide evidence that helps
identify priority districts and number of districts in the
state with public health concern as per the WHO
guidelines.
1
The Data Noteincludes a color-coded
dashboard to compare the coverage of nutrition
interventions across all the districts in the state. It
concludes with key takeaways for children, women, and
men and identifies areas where the state has potential
to improve.
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state factsheets (2019-2020).
Note: Adult nutrition outcomes are based on the woman dataset, while child nutrition outcomes are based on all child data.
1
WHO. Nutrition Landscape Information System (NLiS). Help Topic: Malnutrition in children. Stunting, wasting, overweight and underweight.
(https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=391&lang=EN).
2
In NFHS-3, 40.6% of data was missing, while 1.7% of data was missing in
NFHS-4.
3
NA refers to the unavailability of data for a particular indicator in the specified NFHS round. No. of districts with public health concern
1
: 4 of 4
Map 1 & 2. Number of stunted & anemic children <5y , 2019-2020
Source: IFPRI estimates -The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected population for each district
in 2019. Prevalence estimates were obtained from NFHS-5 (2019-2020; all child data) and projected population for 2019 was estimated using Census 2011.
1
Public health concern is defined as ≥20% for stunting, ≥40% for anemia, ≥10% for wasting, and ≥2% for severe wasting (WHO 2011).
2
The total number of
children <5 years is 48,472.
Map 1. Stunting
Map 3. Wasting
Map 2. Anemia
Highest burden districts
1East District3,800
2West District2,992
3South District 2,906
4North District 1,122
Highest burden districts
1East District3,053
2West District2,505
3South District938
4North District159
Highest burden districts
1East District9,551
2West District7,157
3South District 5,948
4North District 1,696
No. of districts with public health concern
1
: 3 of 4
No. of districts with public health concern
1
: 2 of 4
No. of districts with public health concern
1
: 4 of 4
Number of stunted
children
2
= 10,820
Number of wasted
children
2
= 6,655
Number of anemic
children
2
= 24,352
Map 3 & 4. Number of wasted children <5y, 2019-2020
Map 4. Severe Wasting
Number of severely wasted
children
2
= 3,216
Highest burden districts
1West District1,449
2East District1,196
3South District469
4North District102
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure Map 5 & 6. Number of underweight children (<5y)
& women (15-49y), 2019-2020
Source: IFPRI estimates -The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected population for each district
in 2019. Prevalence estimates were obtained from NFHS-5 (2019-2020; all child/woman data) and projected population for 2019 was estimated using Census
2011.
1
Public health concern is defined as≥20% for underweight (children), ≥10% for underweight (women), ≥40% for anemia among non-pregnant women, and
≥40% for anemia among pregnant women (WHO 2011).
2
The total number of children <5 years is 48,472, pregnant women 15-49 years is 9,237, and non-
pregnant women 15-49 years is 19,2013.
3
Gray area in Map 8 indicates districts for which data are not available.
Map 6. Underweight women
Map 7. Anemia among non-pregnant women Map 8. Anemia among pregnant women
3
Highest burden districts
1East District7,410
2South District 2,211
3West District1,322
4North District438
Highest burden districts
1North District151
Highest burden districts
1East District41,667
2South District 19,177
3West District18,778
4North District 4,765
No. of districts with public health concern
1
: 0 of 4
No. of districts with public health concern
1
: 3 of 4 No. of districts with public health concern
1
: 0 of 4
Number of underweight
women
2
= 11,381
Number of non-pregnant
anemic women
2
= 84,387
Number of pregnant
anemic women
2
=
151
Map 5. Underweight children
Highest burden districts
1East District2,775
2West District2,291
3South District844
4North District540
No. of districts with public health concern
1
: 0 of 4
Number of underweight
children
2
= 6,450
Map 7 & 8. Number of anemic women (15-49y), 2019-2020
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure
Note: Number in ‘000s in the above figureNote: Number in ‘000s in the above figure Category Outcomes
Worst performing
districts (pp)
Best performing
districts (pp)
Highest burden
districts
(thousands)
3
No of
districts with
public health
concern
4
(total=4)
Difference between
(2019-2020) & (2015-
2016)
2
Difference between
(2019-2020) & (2015-
2016)
2019-20202019-2020
Children
<5 years
Overweight/
obesity
North: +1.6
South: +1.5
West: -9.4
East: -0.5
South: 2
East: 1
1
Women
(15-49 years)
Overweight/
obesity
North: +18.7
South: +12.5
Not applicable
5
East: 36
South: 16
4
High blood
pressure
South: +20.0
West: +15.6
Not applicable East: 25
South: 17
4
High blood
sugar
South: +1.3
North: +0.4
West: -3.5 East: 7
South: 3
0
Men
(15-54 years)
Overweight
/obesity
Data not available at district-level
High blood
pressure
North: +14.1
West: +11.6
East: -1.1 East: 29
South: 19
4
High blood
sugar
Not applicable West: -3.3
South: -3.1
East: 6
South: 3
0
Figure 2. Trends in overweight/obesity & NCDs
1
2005-2006, 2015-2016, 2019-2020
Table 1. Overweight/obesity & NCDs
1
at district-level
2015-2016, 2019-2020
2005-2006 2015-2016 2019-2020 India average
1411
10 152735 NA
*
1930 NA76 63736 NA1139 NA108
0
20
40
60
80
100
Overweight/
obesity
Overweight/
obesity
High blood
pressure
High blood
sugar
Overweight/
obesity
High blood
pressure
High blood
sugar
%
Children (<5y)Women (15-49y)Men (15-54y)
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets (2019-2020).pp: percentage points.
Note: Adult nutrition outcomes are based on the woman/man dataset, while child nutrition outcomes are based on all child data.
*
NA refers to the unavailability of data for a particular indicator in the specified NFHS round.
1
NCDs : non-communicable diseases.
2
The difference is calculated only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts
are comparable between 2015-2016 and 2019-2020.
3
Burden: The headcount was calculated as the product of the overweight/obesity and NCDs prevalence and the total eligible projected population for each district
in 2019. Prevalence estimates were obtained from NFHS-5 (2019-2020) and projected population for 2019 was estimated using Census2011.
4
Public health concern is defined as prevalence ≥15% for overweight/obesity (children), ≥20% for overweight/obesity (women andmen), ≥20% high blood
pressure (women and men), and ≥20% high sugar (women and men). Source: WHO (2011).
5
Prevalence did not increase or decrease in any of the districts. Category
Immediate
determinants
Worst performing
districts (pp)
Best performing
districts (pp)
Top coverage
districts (%)
2
Difference between
(2019-2020) & (2015-2016)
1
Difference between
(2019-2020) & (2015-2016)
2019-2020
IYCF
practices
Early initiation of
breastfeeding
South: -50.9
East: -38.2
Not applicable
3
West: 56.2
South: 28.2
Exclusive
breastfeeding
Data not available
Timely introduction of
complementary foods
0
Data not available
Adequate diet
0
South: -1.5
South: +10.2
North: +5.3
West: 28.4
North: 25.3
Maternal
determinants
Women with BMI<18.5
kg/m2
0
East: +2.8
North: +1.6
South: -1.3
West: -0.3
East: 7.7
South: 4.6
Consumed IFA 100+
days
West: -18.2
West: +9.0
East: +5.6
North: 74.0
South: 71.3
Diseases
Diarrhea in the last two
weeks
0
South: +4.5
North: +4.4
Not applicable
South: 4.5
West: 3.3
ARI in the last two
weeks
0
West: +1.5
East: +0.2
North: -0.3
East: 0.5
South: 0
Figure 3. Trends in immediate determinants (%)
2005-2006, 2015-2016, 2019-2020
Table 2. Immediate determinants at district-level
2015-2016, 2019-2020
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets (2019-2020). pp: percentage points.
Note: Immediate determinants are based on the last child data; data on continued breastfeeding at 2 years, egg and/or flesh foods consumption, sweet beverage
consumption, and bottle feeding of infants not available in NFHS-5 factsheets (2019-20)/state report.
0
Indicator definition differs slightly between NFHS-4 and NFHS-5.
1
The difference is calculated only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts are comparable between 2015-2016
and 2019-2020.
2
For all indicators, top coverage districts refer to the districts with the highest prevalence in immediate determinants, except for women with a BMI of 18.5 kg/m2,
diarrhea in the last two weeks, and ARI in the last two weeks, for which it refers to the districts with the lowest prevalence in coverage.
3
Prevalence did not increase or decrease in any of the districts. Category
Underlying
determinants
Worst performing
districts (pp)
Best performing
districts (pp)
Top coverage
districts (%)
2
Difference between
(2019-2020) & (2015-2016)
1
Difference between
(2019-2020) & (2015-2016)
2019-2020
Maternal
determinants
Women who are literate
0
West: -2.7
North: -2.6
South: +4.9
East: +4.6
South: 90.5
East: 90.1
Women with ≥10 years
education
0
Not applicable
3
West: +18.9
South: +16.5
East: 53.2
South: 45.7
Girls 20-24 years married
before age of 18 years
0
Not applicable
East: -30.4
South: -26.5
East: 1.7
South: 8.7
Women 15-19 years with
child or pregnant
South: +6.7
North: +1.4
East: -2.1
East: 1.7
West: 2.5
Household
determinants
HHs with improved
drinking water source
0
South: -5.4
East: -4.2
Not applicable
North: 94.7
East: 93.6
HHs with improved
sanitation facility
0
West: -4.6
North: -2.8
East: +7.8
South: 91.7
West: 88.9
HHs with electricity
0
West: -1.2
North, South: -0.4
East: +0.9
South: 99.6
East: 99.4
Figure 4. Trends in underlying determinants (%)
2005-2006, 2015-2016, 2019-2020
Table 3. Underlying determinants at district-level
2015-2016, 2019-2020
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets and state reports (2019-2020).
Note: Underlying determinants are based on the last child data; safe disposal of feces not available in NFHS-5 factsheets (2019-20)/state report and data on HHs
with hand washing facility not available in NFHS-3 (2005-06) and NFHS-5 factsheets (2019-20)/state report. Data on open defecation and HHs with BPL card for
2019-2020 are taken from NFHS-5 state reports.
0
Indicator definition differs slightly between NFHS-4 and NFHS-5.
1
The difference is calculated only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts are comparable between 2015-16 and
2019-20.
2
For all indicators, top coverage districts refer to the districts with the highest prevalence in underlying determinants, exceptfor girls 20-24 years married
before age of 18 years and women 15-19 years with child or pregnantfor which it refers to the districts with the lowest prevalence in coverage.
3
Prevalence did not increase or decrease in any of the districts. Figure 5. Trends in interventions across the first 1000 days (%)
2005-2006, 2015-2016, 2019-2020
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016) & NFHS-5 state factsheets and state reports (2019-2020).
0
Indicator comparable between NFHS-3 and NFHS-4 but differs slightly from NFHS-5.
Note 1: Interventions’ coverage is based on the last child data.
Note 2: The following information is not available in the NFHS-5 factsheets and state reports (2019-20): receipt of at least oneANC visit, birth preparedness
counselling, malaria prevention and food supplementation (6-35m). Information on use of bed nets during pregnancy is not available in NFHS-3 data (2006).
Note 3: Data on food supplementation and health and nutrition education during pregnancy and post-natal care, and weight measurement during childhood and
counselling on child growth for 2019-2020 are taken from NFHS-5 state reports.
Note 4: Refer to district dashboard for the inter-district variability in the coverage of interventions. Intervention coverage at district level, 2019-2020
Source: NFHS
-
5 district factsheets and state reports (2019
-
20).
Note 1: The following information is not available in the NFHS
-
5 factsheets and state reports (2019
-
20): (1) Information on pre
conception and pregnancy
-
related indicators including demand for FP satisfied,
receipt of at least one ANC visit, weighing, birth preparedness and breastfeeding counselling, counselling on keeping baby wa
rm,
cord care counselling, food supplementation, health and nutrition education and
malaria prevention; (2) Lactation
-
related indicators including, food supplementation and health and nutrition education; and (3)
early childhood
-
related indicators including pediatric IFA, deworming, food
supplementation (6
-
35m), weighing and counselling on child growth. Information on use of bed nets during pregnancy not available
in NFHS
-
3 data (2005
-
2006).
Note 2: Food supplementation during early childhood is for children aged 6
-
35 months; counselling on child growth during early c
hildhood is conducted after taking weight measurement. District name
Demand for FP
satisfied
Iodized salt
Any ANC visits
ANC first trimester
≥4 ANC
Received MCP card
Received IFA
tab/syrup
Tetanus injection
Deworming
Weighing
Birth preparedness
counselling
Breastfeeding
counselling
Counselling on
keeping baby warm
Cord care counselling
Food supplementation
Health & nutrition
education
Malaria prevention-
use of bed nets
Institutional birth
Financial assistance
(JSY)
Skilled birth attendant
Postnatal care for
mothers
Postnatal care for
babies
Food supplementation
Health & nutrition
education
Full immunization
Vitamin A
Paediatric IFA
Deworming
Care seeking for ARIORS during diarrheaZinc during diarrhea
Food supplementation
(6-35 months)
Weighing
Counselling on child
growth
SIKKIM98.3 63.758.494.694.492.029.694.75.896.569.366.2 80.687.5 59.564.250.0
East District97.7 53.443.891.993.390.331.691.84.294.265.859.291.2 63.4
North District99.0 66.259.495.595.292.532.597.314.698.571.372.0 90.890.1
South District99.4 78.184.599.496.792.335.097.45.699.483.181.1 86.488.4
West District98.1 75.870.496.494.595.917.799.37.599.363.667.8 96.972.2
<25%50-<75% >75%
Pre-
pregnancy
PregnancyDelivery & postnatalEarly childhood
Source: NFHS-5 factsheets (2019)Not Available25-<50% Category Interventions
Worst performing
districts (pp)
Best performing
districts (pp)
Top coverage
districts (%)
Difference between
(2019-2020) & (2015-2016)
1
Difference between
(2019-2020) & (2015-2016)
2019-2020
ANC first trimester
East: -16.4
North: -14.7
Not applicable
2
South: 78.1
West: 75.8
Pregnancy
≥4 ANC visits
East: -24.3
West: -14.5
Not applicable
South: 84.5
West: 70.4
Received MCP Card
East: -6.3
North: -3.1
South: +2.2
West: +0.5
South: 99.4
West: 96.4
Tetanus injection
South: -7.7
East: -5.0
Not applicable
West: 95.9
North: 92.5
Delivery and
post-natal
Institutional birth
0
East: -1.5
South: -0.9
West: +3.3
North: +0.7
West: 95.9
North: 92.5
Skilled birth attendant
0
East: -2.3
North: -0.8
West: +2.0
West: 99.3
South: 97.4
Postnatal care for
mothers
North: -13.4
West: -10.1
South: +0.4
South: 83.1
North: 71.3
Postnatal care for
babies
0
Not applicable
South: +57.0
North: +54.9
South: 81.1
North: 72.0
Early
childhood
Full immunization
South: -5.2West: +17.5
North: +0.9
West: 96.9
North: 90.8
Vitamin A
supplementation
0
West: -3.0
East: +11.0
South: +5.6
East: 91.2
North: 90.1
Care seeking for ARI
0
East: -1.2Data not available East: 63.4
ORS treatment during
diarrhea
0
Data not available
Zinc treatment during
diarrhea
0
Data not available
Table 4. Intervention coverage at district-level
2015-2016, 2019-2020
Key takeaways
Children: Stunting prevalence declined by 10 percentage points (pp) between 2006 to 2016 and by 7pp between
2016 to 2020. Underweight declined by 6pp between 2006 and 2016 and by 1pp between 2016 and 2020. Anemia
declined by 1pp between 2006 and 2016 and did not change between 2016 and 2020.
Women: Underweight declined by 5pp between 2006 and 2016 and remained constant between 2016 and 2020.
Anemia among non-pregnant and pregnant women declined by 24pp and 36pp, respectively, between 2006 and 2016.
But it increased by 7pp and 17pp among non-pregnant and pregnant women, respectively, between 2016 and 2020.
Overweight/obesity increased by 12pp between 2006 and 2016 and by 8pp between 2016 and 2020.
Men: Overweight/obesity increased by 31pp between 2006 and 2016 and decreased by 1pp between 2016 and 2020.
Attention is needed to improve (%s in 2020):
• Outcomes: Stunting (22%) and anemia in children (56%); anemia in non-pregnant (42%) and pregnant (41%)
women
• Immediate determinants:Early initiation of breastfeeding (33%); exclusive breastfeeding (28%); adequate diet
(25%); 100+ IFA (55%)
• Underlying determinants:Women with 10 years education (49%)
• Coverage of interventions:4 ANC visits (58%);food supplementation (46-53%); health and nutrition
education for women (42-49%); postnatal care for mothers (69%) and babies (66%); ORS (64%) and zinc (50%)
during diarrhea; growth monitoring of children (62%)
Source: NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 state and district factsheets (2019-2020). pp: percentage points
Note: Interventions’ coverage are based on the last child data.
0
Indicator definition differs slightly between NFHS-4 and NFHS-5.
1
The difference is calculated
only between districts that are comparable between 2015-2016 and 2019-2020. All 4 districts are comparable between 2015-16 and 2019-20.
2
Prevalence did
not increase or decrease in any of the districts. Indicator definition
Nutrition outcomesDefinition
Low birth weight
Percentage of live births in the five years preceding the survey with a reported birth weight less than 2.5 kg, based on
either a written record or the mother's recall
Stunting among children Percentage of children aged 0-59 months who are stunted i.e., height-for-age z score < -2SD
Wasting among children Percentage of children aged 0-59 months who are wasted i.e., weight-for-height z score < -2SD
Severe wasting among children Percentage of children aged 0-59 months who are wasted i.e., weight-for-height z score < -3SD
Underweight childrenPercentage of children aged 0-59 months who are underweight i.e., weight-for-age z score < -2SD
Anemia among children Percentage of children aged 6-59 months who are anemic i.e., (Hb <11.0 g/dl)
Underweight womenPercentage of women aged 15-49 whose Body Mass Index (BMI) is below normal (BMI <18.5 kg/m2)
Anemia among non-pregnant
women
Percentage of non-pregnant women aged 15-49 who are anemic (<12.0 g/dl)
Anemia among pregnant women Percentage of pregnant women aged 15-49 who are anemic (<11.0 g/dl)
Overweight/obesity -children Percentage of children aged 0-59 months who are overweight i.e., weight-for-height z score > 2SD
Overweight/obesity -women Percentage of men aged 15-54 who are overweight or obese (BMI ≥25.0 kg/m2)
Overweight/obesity -men Percentage of men aged 15-54 who are overweight or obese (BMI ≥25.0 kg/m2)
High blood pressure among women^Percentage of women aged 15-49 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High blood pressure among men^ Percentage of men aged 15-54 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High sugar level among women^ Percentage of women aged 15-49 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High sugar level among men^ Percentage of men aged 15-54 with high blood sugar levels (141-160 mg/dl)
Immediate determinants
Early initiation of breastfeeding
Percentage of children under aged 3 years breastfed within one hour of birth for the last child born in the 3 years
before the survey
Exclusive breastfeeding Percentage of youngest children under age 6 months living with mother who were exclusively breastfed
Timely introduction of
complementary foods
0
1
Percentage of youngest children aged 6-8 months living with mother who received solid or semi-solid food during the
previous day;
2
Percentage of youngest children aged 6-8 months living with mother who received solid or semi-solid
food and breastmilk
Continued breastfeeding at 2 years
$
Percentage of youngest children 12–23 months of age who were fed breast milk during the previous day
Adequate diet
Percentage of youngest children 6–23 months of age who consumed a minimum acceptable diet during the previous
day
Eggs and/or flesh foods
consumption
$
Percentage of youngest children 6–23 months of age who consumed egg and/or flesh food during the previous day
Sweet beverage
$
Percentage of youngest children 6–23 months of age who consumed a sweet beverage during the previous day
Bottle feeding for infants
$
Percentage of youngest children 0–23 months of age who were fed from a bottle with a nipple during the previous day
Women with body mass index
<18.5 kg/m
2 0
1
Percentage of women aged 15-49 with a youngest child < 5 years who have BMI below normal (BMI <18.5 kg/m2) ;
2
Percentage of women aged 15-49 whose BMI is below normal (BMI <18.5 kg/m
2
)
Consumed IFA 100+ days
Percentage of mothers aged 15-49 who consumed iron folic acid for 100 days or more during the last pregnancy in
last five years preceding the survey
Diarrhea in the last two weeks
0
1
Percentage of youngest children under age five who had diarrhea in the two weeks preceding the survey;
2
Percentage of children under age 5 who had diarrhea in the 2 weeks preceding the survey
ARI in the last two weeks
0
1
Percentage of youngest children under age five who had symptoms of acute respiratory infection (ARI) in the two
weeks preceding the survey;
2
Percentage of children under age five who had symptoms of acute respiratory
infection (ARI) in the two weeks preceding the survey
Underlying determinants
Women who are literate
0
1
Percentage of women aged 15-49 with a birth in five years preceding the survey who are literate i.e., those who
completed standard 6 or higher and can read a whole sentence;
2
Percentage of women aged 15-49 who are literate
i.e., those who completed standard 9 or higher and can read a whole sentence or part of a sentence.
Women with ≥10 years education
0
1
Percentage of women aged 15-49 with a birth in five years preceding the survey with 10 or more years of schooling;
2
Percentage of women aged 15-49 with 10 or more years of schooling
Girls 20-24 years married before
age of 18 years
0
1
Percentage of women aged 20-24 years with a birth in five years preceding the survey who were married before age
18 years;
2
Percentage of women aged 20-24 years who were married before age 18 years
Women 15-19 years with child or
pregnant
Percentage of currently married women aged 15-49 who had their first birth before age 20 years and in the five years
preceding the survey
HHs with improved drinking water
source
0
1
Percentage of youngest children under age 5 living in household that use an improved source of drinking water;
2
Population living in households that use an improved sanitation facility
HHs with improved sanitation
facility
0
1
Percentage of youngest children under age 5 living in household that uses improved toilet facility;
2
Population living
in households that use an improved sanitation facility
HHs with hand washing facility
^$
Percentage of youngest children under age 5 living in household that had soap and water for washing hands
Open defecation
@
Percentage of youngest children under age 5 living in household that has no toilet facility/defecates in open
Safe disposal of feces
$
Percentage of youngest children living with mother whose stools were disposed of safely
HHs with BPL card
@
Percentage of youngest children under age 5 living in households with BPL card
HHs with electricity
0
1
Percentage of youngest children under age 5 living in household that has electricity;
2
Population living in households
with electricity
^
Indicator not available in NFHS-3.
$
Indicator not available in NFHS-5 factsheets/state reports
0
Indicator comparable between NFHS-3 and NFHS-4
but differs slightly from NFHS-5.
@
Indicator not available in NFHS-5 factsheets but available in NFHS-5 states reports.
1
Definition per NFHS-3/NFHS-4.
2
Definition as per NFHS-5 factsheet. Indicator definition
InterventionsDefinition
Demand for FP satisfied
@
Percentage of currently married women aged 15-49 with demand for family planning satisfied by modern methods
Iodized salt
01
Percentage of women aged 15-49 living in HHs that use iodized salt;
2
Percentage of households using iodized salt
Any ANC visits
$
Percentage of women aged 15-49 with a live birth in the five years who received at least one ANC for the last birth
ANC first trimesterPercentage of women (15-49 years of age) attended by any provider during the first trimester of pregnancy that led to
the birth of the youngest child in the last 2 years
≥ 4ANCPercentage of mothers aged 15-49 who had at least 4 antenatal care visits for last birth in the 5 years before the
survey
Received MCP cardPercentage of mothers who registered last pregnancy in the 5 years preceding the survey for which she received a
Mother and Child Protection (MCP) card
Received IFA tab/syrup
@
Percentage of women who received IFA (given or purchased) tablets during the pregnancy for their most recent live
birth in the 5 years preceding the survey
Tetanus injectionPercentage of women whose last birth was protected against neonatal tetanus (for last birth in the five years
preceding the survey )
Deworming-pregnancy
@
Percentage of women who took an intestinal parasite drug during the pregnancy for their most recent live birth in the
5 years preceding the survey
Weighing-pregnancy
@
Percentage of women aged 15-49 with a live birth in the five years preceding the survey who were weighed during
ANC for the last birth
Birth preparedness counselling
$
Percentage of women who had at least one contact with a health worker in the three months preceding the survey
and were counselled on birth preparedness; calculated among women aged 15-49 who gave birth in the five years
preceding the survey
Breastfeeding counselling
@
Percentage of women who met with a community health worker in the last three months of pregnancy and received
advice on breastfeeding (for the last pregnancy in the five years preceding the survey)
Counselling on keeping baby
warm
@
Percentage of women who met with a community health worker in the last three months of pregnancy and received
advice on keeping the baby warm for their most recent live birth in the five years preceding the survey
Cord care counselling
^@
Percentage of women who met with a community health worker in the last three months of pregnancy and received
advice on cord care for their most recent live birth in the five years preceding the survey
Food supplementation -
pregnancy
@
1
Percentage of youngest children under age 5 whose mother received supplementary food from AWC during
pregnancy;
3
Among children under 6 years, percentage whose mother received specific benefits from AWC during
pregnancy: supplementary food
Health & nutrition education –
pregnancy
@
1
Percentage of mothers who received health and nutrition education from an Anganwadi Centre (AWC) during last
pregnancy in the five years preceding the survey;
3
Among children under 6 years, percentage whose mother received
specific benefits from AWC during pregnancy: health and nutrition education
Malaria prevention-use of bed
nets
^$
Percentage of women who used mosquito net during the pregnancy for their most recent live birth in the 5 years
preceding the survey
Institutional birth
01
Percentage of women aged 15-49 who gave birth in health/institutional facility for their most recent live birth in the 5
years preceding the survey;
2
Percentage of live births to women aged 15-49 in the five years preceding the survey
that took place in a health/institutional facility
Financial assistance (JSY)
@
Percentage of women who received financial assistance under JSY for their most recent live birth that took place in
institutional facility in the 5 years preceding the survey
Skilled birth attendant
01
Percentage of women whose last delivery was attended by a skilled health personnel for their most recent live birth
in the 5 years preceding the survey;
2
Percentage of births attended by skilled health personnel for births in the 5
years before the survey
Postnatal care for mothers Percentage of mothers who received postnatal care from a doctor/nurse/LHV/ANM/midwife/other health personnel
within 2 days of delivery for their most recent live birth in the five years preceding the survey
Postnatal care for babies Percentage of children who received postnatal care from a doctor /nurse /LHV /ANM /midwife /other health personnel
within 2 days of delivery for last birth in the 5 years before the survey
Food supplementation –postnatal
@ 1
Percentage of youngest children under age 5 whose mother received supplementary food from AWC while
breastfeeding;
3
Among children under 6 years, percentage whose mother received specific benefits from AWC while
breastfeeding: supplementary food
Health & nutrition education –
postnatal
@
1
Percentage of youngest children under age 5 whose mother received health check-ups from AWC while
breastfeeding;
3
Among children under 6 years, percentage whose mother received specific benefits from AWC while
breastfeeding: health and nutrition education
Full immunization
01
Percentage of youngest living children aged 12-23 months fully vaccinated based on information from either
vaccination card or mother's recall;
2
Percentage of children aged 12-23 months fully vaccinated based on information
from either vaccination card or mother's recall
Vitamin A –early childhood
01
Percentage of youngest children aged 6-59 months who received Vitamin A supplementation in the last 6 months
preceding the survey; 2 Percentage of children aged 9-35 months who received a vitamin A dose in the last 6 months
Pediatric IFA
0@
Percentage of youngest children aged 6-59 months who received iron supplements in the past 7 days preceding the
survey
Deworming –early childhood
0@
Percentage of youngest children aged 6-59 months who received deworming tablets in the last 6 months preceding
the survey
Care seeking for ARI
01
Percentage of youngest children under age 5 years with fever or symptoms of ARI in the 2 weeks preceding the
survey taken to a health facility or health provider;
2
Percentage of children under age 5 years with fever or symptoms
of ARI in the 2 weeks preceding the survey taken to a health facility or health provider
ORS during diarrhea
01
Percentage of youngest children under age 5 years with diarrhea in the 2 weeks preceding the survey who received
oral rehydration salts (ORS); 2Percentage of children under age 5 years with diarrhea in the 2 weeks preceding the
survey who ORS
Zinc during diarrhea
01
Percentage of youngest children under age 5 years with diarrhea in the 2 weeks preceding the survey who
received zinc;
2
Percentage of children under age 5 years with diarrhea in the 2 weeks preceding the survey who
received zinc
Food supplementation (children 6-
35 months)
$
Percentage of youngest children aged 6-35 months who received food supplements from AWC in the 12 months
preceding the survey
Weighing –early childhood
@
Percentage of youngest children under age 5 who were weighed at AWC in the 12 months preceding the survey
Counselling on child growth
@
Percentage of youngest children under age 5 whose mother received counselling from an AWC after child was
weighed in the 12 months preceding the survey
^
Indicator not available in NFHS-3.
$
Indicator not available in NFHS-5 factsheets/state reports.
@
Indicator not available in NFHS-5 factsheets but available in
NFHS-5 states reports.
0
Indicator comparable between NFHS-3 and NFHS-4 but differs slightly from NFHS-5.
1
Definition per NFHS-3/NFHS-4.
2
Definition as per NFHS-5 factsheet.
3
Definition as per NFHS-5 state reports. ABOUT POSHAN
Partnerships and Opportunities to
Strengthen and Harmonize Actions
for Nutrition in India (POSHAN) is a
multi-year initiative that aims to
support the use of data and evidence
in decision-making for nutrition in
India. It is supported by the Bill &
Melinda Gates Foundation and led by
IFPRI in India.
http://poshan.ifpri.info/
ABOUT DATA NOTES
POSHAN Data Notes focus on data
visualization to highlight geographic
and/or thematic issues related to
nutrition in India. They draw on
multiple sources of publically
available data.
CONTACT US
Email: IFPRI-POSHAN@cgiar.org
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Copyright © 2021 International Food
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contact ifpri-copyright@cgiar.org.
AUTHORS
Sattvika Ashok, Research Analyst, IFPRI
Rasmi Avula, Research Fellow, IFPRI
S.K. Singh, Professor, IIPS
Rakesh Sarwal, Additional Secretary, NITI Aayog
Neena Bhatia, Senior Specialist, NITI Aayog
Robert Johnston, Nutrition Specialist UNICEF
William Joe, Assistant Professor, IEG
Purnima Menon, Senior Research Fellow, IFPRI
Phuong Hong Nguyen, Senior Research Fellow, IFPRI
Disclaimer: The maps used in this Data Note are based on the districts in NFHS-5
factsheets/reports . The boundaries shown do not imply any official endorsement or
acceptance by IFPRI.
SUGGESTED CITATION
Ashok, A., R. Avula, S.K. Singh, R. Sarwal, N. Bhatia, R.
Johnston, W. Joe, P. Menon, and P.H. Nguyen. 2021.
State Nutrition Profile Sikkim. POSHAN Data Note 53. New
Delhi, India: International Food Policy Research Institute.
ACKNOWLEDGEMENTS
Financial support for this Data Note was provided by the
Bill & Melinda Gates Foundation through POSHAN, led by
the International Food Policy Research Institute. The
funder played no role in decisions about the scope of the
analysis or the contents of the Note.
We thank Long Quynh Khuong(Independent Researcher)
for creating the maps, Nishmeet Singh (IFPRI) and Anjali
Pant (IFPRI) for working with the dataset and Julie
Ghostlaw (IFPRI) & Abhilasha Vaid (Consultant) for
editing and reviewing the Note.
PARTNERS
Institute of Economic Growth (IEG)
International Institute for Population Science (IIPS)
NITI Aayog
UNICEF