VITAMIN A SUPPLEMENTATION COVERAGE AMONG CHILDREN

AGED 6 TO 59 MONTHS IN INDIA: SPATIAL HETEROGENEITY

AND CONTEXTUAL DETERMINANTS

SUBMITTED BY
PRASENJIT DE

Term Paper submitted for the partial fulfilment of the Master of Population
Studies during the academic year 2021-22

Under the Supervision and Guidance of

PROF. D. A. NAGDEVE
Department of Fertility Studies and Social Demography

INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES

Govandi Station Road, Deonar

Mumbai-400088, India

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 ACKNOWLEDGEMENT

I would like to express my sincere gratefulness to my supervisor Prof. D. A. Nagdeve,

Department of Fertility Studies and Social Demography for his expert guidance, constant
motivation and illuminating advices and suggestions to complete my term paper within the
prescribed time period.
I would also like to express my profound sense of gratitude to Prof. K.S. James, Director,
International Institute for Population Sciences and MPS course coordinators Dr. Harihar
Sahoo and Dr. Suresh Jungari for giving me an opportunity to pursue the course at the
institute.
I would like to express my gratitude to the panel committee members Prof. R. Nagarajan,
Prof. C. J. Sonowal and chairperson Prof. C. Sekhar for their valuable suggestion regarding
my term paper.
I am also very grateful to the staffs of library and ICT Unit who gave access to the library and
Wi-Fi access.
I would like to appreciate my friends and seniors who directly or indirectly are involved in the
successful completion of my term paper.
Finally, I express my adoration and deep faith in the Almighty God whose blessings give the
strength and enthusiasm to complete this work.

PRASENJIT DE
Master of Population Studies
Enrolment No- IIPS/MPS (2021-22)/14
IIPS, Mumbai

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 Table of Contents
INTRODUCTION: ....................................................................................................................... 5
REVIEW OF LITERATURE: ................................................................................................... 6
RATIONALE BEHIND THE STUDY: .................................................................................... 7
RESEARCH QUESTION: .......................................................................................................... 7
OBJECTIVES: .............................................................................................................................. 7
DATA AND METHODS: ............................................................................................................ 8
Data Source ................................................................................................................................ 8
Outcome Variable ..................................................................................................................... 8
Predictor Variable .................................................................................................................... 8
Spatial Analysis ......................................................................................................................... 8
Statistical Analysis .................................................................................................................... 9
RESULTS: ..................................................................................................................................... 9
Coverage Gap ............................................................................................................................ 9
Spatial Clustering ................................................................................................................... 10
Descriptive Statistics............................................................................................................... 11
Vitamin A Supplementation by Background Characteristics ......................................... 11
Association Between Vitamin A supplementation and Demographic and Socio-
economic Characteristics ....................................................................................................... 12
DISCUSSION: ............................................................................................................................. 12
LIMITATION AND STRENGTH OF THE STUDY: - ....................................................... 13
CONCLUSION: .......................................................................................................................... 14
REFERENCES: .......................................................................................................................... 14

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VITAMIN A SUPPLEMENTATION COVERAGE AMONG CHILDREN
AGED 6 TO 59 MONTHS IN INDIA: SPATIAL HETEROGENEITY
AND CONTEXTUAL DETERMINANTS

INTRODUCTION: -
Vitamin A is a vital vitamin that plays a crucial role in immunological function. Inadequate
vitamin A consumption during periods of rapid growth can lead to deficiency, which can cause
visual impairment (night blindness) and raise the risk of morbidity and mortality from common
childhood diseases in severe cases (UNICEF, 2018). The global burden of vitamin A
deficiency is significant, and the WHO advises high-dose vitamin A supplementation for
children aged 6 to 59 months in areas where it is a public health issue (WHO, 2011). Its deficit
is more common in young children. Micro-nutrient deficiencies are common in low- and
middle-income nations, such as India, due to insufficient food consumption, infections, and/or
chronic inflammation, all of which can lead to poor nutrient absorption or increased catabolism.
(Reddy et al., 2020). Micro-nutrient deficits are commonly referred to as "hidden hunger"
since they build over time (Srivastava and Kumar, 2021). The consequences are long-term,
and the devastation is not obvious until permanent damage has occurred (Srivastava and
Kumar, 2021). Vitamin A deficiency raises the risk of sickness and mortality from serious
infections among children. (Bahl et al., 2012). Eye injury can result from severe vitamin A
deficiency (VAD). Infections like measles and diarrheal diseases in children might be made
worse by VAD, and recovery from illness can be slowed. A sufficient amount of vitamins can
be stored in the human liver for four to six months. Vitamin A supplementation regularly
(typically every six months) is one way to ensure that children at risk do not develop VAD
(WHO, 2011).

There has been a significant rise in global attention and commitment to the control and
elimination of micro-nutrient deficiency over the last two decades (Mason et al., 2001). Nearly
100 million of the world's 140 million children with vitamin A deficiency live in South Asia
(including India) or Sub-Saharan Africa. (Mason et al., 2001). VAD has long been recognized
as the major cause of preventable blindness in children, and India was the first country to adopt
high-dose vitamin A supplementation on a large geographical scale, beginning in 1970 with a
few states. Children aged 9 months to 3 years are given six-monthly doses of vitamin A through
this program, which is supported by the Ministry of Health and Family Welfare of the
Government of India. Some Indian states have elected to extend this term to cover children
until they reach the age of five, as recommended by the World Health Organization (WHO).
The first two doses are given in conjunction with normal immunization. Although the
supplementing program was launched as a temporary remedy to protect youngsters from
becoming blind, it has continued (Agrawal and Agrawal, 2013). Vitamin A supplementation
is being carried out in India through a network of primary health centers and sub-centers.
Vitamin A supplements are administered to children aged 9 to 35 months by a female

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multifunctional worker and other paramedics from the health facilities. The program is also
implemented using the services of the Integrated Child Development Scheme (ICDS) officials
(Kapil, 2002).

Vitamin A supplementation among children has considerably increased over the decades in
India. From 18 percent of children aged 6 to 59 months, received vitamin A supplementation
in 2005-06 (NFHS-3), it was increased up to 59.5 percent in 2015-16 (NFHS-4). The
percentage of children aged 6-59 months given Vitamin A supplements in the last six months
ranges from 29 percent in Nagaland and 31 percent in Manipur to 89 percent in Goa. From the
report of NFHS-4, there was evidence that inequality exists in the coverage of vitamin A
supplementation across the states. Vitamin A insufficiency has been linked to birth order,
child’s age, maternal education, and household wealth status (Chaudhri et al., 2018;
Srivastava and Kumar, 2021).

REVIEW OF LITERATURE: -
Choi et al. (2005) tried to find out differences in receipt of vitamin A by socio-economic status
using the Demographic and Health Survey data from the Philippines. The adjusted odds of
vitamin A intake by poor households compared to middle-class households decreased from 27
percent in 1993 to 48 percent in 1998.
Another study done by Semba et al. (2008) was to determine the extent to which the Ethiopian
national vitamin A program covered preschool children and to identify risk factors for vitamin
A deficiency. This study also revealed that maternal and paternal more years of formal
education was positively associated with the child obtaining a vitamin A pill compared to no
years of formal parental education. Stunting, underweight, and wasting were not significantly
different in children who received or did not receive a vitamin A capsule.

Agrawal and Agrawal (2013) examined vitamin A supplementation among preschool

children in India and how it relates to their socioeconomic and demographic traits as well as
the level of social and economic development in the state where they live. This study was based
on NFHS-3 data. Adjusted and unadjusted logistic regression models had been used to establish
the association of vitamin A supplementation with background characteristics. Children lived
in rural areas area and children of educated mothers were more likely to receive vitamin A
while those who lived in states with low levels of social and economic development were only
about half as likely as their counterparts to receive vitamin A supplementation.
The study by Khan et al. (2019) and Panda et al. (2019) provided insightful information and
methodological clarification related to spatial heterogeneity, although those study was focused
on spatial heterogeneity of hepatitis B vaccination coverage across India and geospatial
analysis of full immunization coverage across districts of India respectively.

Another study by Reddy et al. (2020) found that the risk of biochemical VAD in Indian
children under the age of five, as well as dietary vitamin A deficiency and excess over the
tolerated upper limit of intake (TUL) in national and subnational surveys. In Indian children,
the countrywide prevalence of vitamin A deficiency risk is less than 20 percent because of the

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potential of overconsumption associated with food fortification and Vitamin A
supplementation.
Srivastava and Kumar (2021) estimated the socio-economic discrepancies in vitamin A
supplementation (VAS) and iron supplementation (IS) among children aged 6–59 months in
India, as well as the change in the percent contribution of several socio-economic, correlates
to such inequality from 2005–06 to 2015–16. This study revealed that from 2005–06 to 2015–
16, the percentage of children who do not receive vitamin A supplementation decreased from
85.5 percent to 42.1 percent, while the percentage of children who do not receive IS decreased
from 95.3 percent to 73.9 percent. The child's age, mother's educational status, birth order,
breastfeeding status, place of residence, and state's empowered action group (EAG) status were
all found to be significant determinants in vitamin A and iron supplementation among Indian
children. Furthermore, children who do not receive vitamin A or iron supplementation were
shown to be more concentrated among children from lower socioeconomic backgrounds.

A study by Rai (2022) examined the impact of vitamin A supplementation on two nutritional
indicators in children aged 6–59 months: anaemia (defined as any anaemia and mild/moderate
anaemia) and anthropometric failure (defined as stunting, wasting, and underweight). Vitamin
A supplementation does not effect on any sort of childhood anaemia or anthropometric failure
in India, according to findings from both the household fixed-effects and mother fixed-effects
analyses.

RATIONALE BEHIND THE STUDY: -

There are few studies on the factors that influence vitamin A supplementation among children
aged 6 to 59 months in India. The essential associations of vitamin A coverage in children aged
6–59 months in India have been discovered in a variety of studies but there is hardly any
literature that focused on the spatial pattern and heterogeneity of vitamin A supplementation at
the district level. In the view of above, the present study is an attempt to examine district-level
variation in vitamin A supplementation coverage among children aged 6 to 59 months in India
and its association with several demographic and socio-economic characteristics and how they
affect vitamin A supplementation coverage in India.

RESEARCH QUESTION: -
➢ What is the coverage gap of vitamin A supplementation among children aged 6 to 59
months across the districts of India?
➢ What and how various demographic and socio-economic factors are associated with
vitamin A supplementation among the children in India.

OBJECTIVES: -
1. To study the district-level coverage gap in vitamin A supplementation among children
aged 6 to 59 months.
2. To examine spatial clustering in vitamin A supplementation coverage at the district
level.
3. To determine demographic and socioeconomic correlates of vitamin A
supplementation.

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DATA AND METHODS:
Data Source
The data from National Family Health Survey- Round 4 (2015-16) has been used in the present
study. NFHS is an Indian version of the Demographic Health Survey. The main objectives of
this survey are to provide detailed and reliable information on a wide range of demographic
socio-economic and health information of individuals such as women’s reproductive health,
nutritional status of children, fertility and family planning services, utilization of women and
child health care services, women empowerment, domestic violence, etc. It is based on a two-
stage sampling procedure and details on sampling procedure, sample size estimation and
weight estimation are provided in the report (IIPS and ICF, 2017).

The survey, collected data from 699,686 women in the age group 15-49, 112,122 men in the
age group 15-54 and 259,627 children. In this study data from children’s series has been used
for analysis purposes. Out of 259,627 children aged 6 to 59 months has been considered for
Vitamin A supplementation coverage in the last 6 months before the survey. After eliminating
missing cases of eligible variables, a total of 210350 weighted samples have been finally
selected for the current study.

Outcome Variable
The outcome or dependent variable for the study was vitamin A supplementation among
children aged 6-59 months. The question was asked about ‘whether vitamin A dose was given
in the last six months?’ to the respondent and the response was recorded as either 0 “no” or 1
“yes” (according to vaccination card or mothers recall). Children who did not receive the
supplementation were considered to be deficient in vitamin A.

Predictor Variable
A wide range of socio-economic and demographic variables have been considered for this
study that was also significantly associated with vitamin A supplementation coverage. The
predictor variables included in the study are children’s age recoded into 6-26, 27-37, and 38-
59; birth order recoded as 1, 2-3, 4-5 and 6+; sex of child coded as male and female; child
lives with whom coded as with respondent and lives elsewhere; mother’s educational status
coded as no education, primary or less, secondary or less and higher; caste recoded as ST, SC,
OBC and others (others included other than SC, ST and OBC); religion recoded as Hindu,
Muslims, Christian and others (Other religious category included
Jain/Sikh/Jewish/Buddhist/others); place of residence coded as urban and rural; mass media
exposure recoded as no and yes; wealth quantile coded as poorer, poorest, middle, richer and
richest.
Spatial Analysis
Spatial analysis has been done to meet the demand of 1st and 2nd objectives. At first district-
wise coverage gap map of vitamin A supplementation has been prepared for 640 districts across
36 States and UTs in India. To understand spatial clustering in vitamin A supplementation
across the districts of India, Moran’s I indices have been generated through spatial weight
matrix (Wi) by using the queen contiguity method of order 1. Moran’s, I value lies between -1
and +1. A positive value indicates spatial clustering of observation and a negative value
indicates observations on space are more scattered. The zero value of Moran’s I indicates

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observations in the space are haphazard (Panda et al., 2019). Univariate Local Indicator of
Spatial Association (LISA) cluster and significance analysis has been carried out in order to
identify spatial autocorrelation (hot and cold spots) of vitamin A supplementation across
districts in India. ArcGIS version 10.8 and Geo-Da version 1.20.0.8 has been used for spatial
analysis.

Statistical Analysis
Descriptive statistics and bivariate and multivariate analysis has been carried out for analysis
purpose in the present study. Descriptive statistics have been performed to examine the
background characteristics of the study sample. Bivariate analysis with Pearson Chi-square
significance test has been carried out to find out the level and patterns of vitamin A
supplementation by background characteristics. Binary logistic regression has been carried out
to determine socio-economic and demographic correlates of vitamin A supplementation. In
binary logistic regression, the outcome variable of received vitamin A supplementation in the
last 6 months is dichotomous - no (0) and yes (1).

RESULTS:
Coverage Gap
Almost 59 percent of children aged 6 to 59 months have received vitamin A supplementation
in India in 2015-16. District-level coverage of vitamin A supplementation among children in
India has been depicted in Figure 1. Out of a total 640 of districts, 20 districts have very low
vitamin A supplementation coverage i.e., less than 22 percent, and 99 districts with low
coverage ranging from 23 to 43 percent. Most of the lower coverage districts belong to Uttar
Pradesh, Rajasthan and most of the districts from North-Eastern states. A total of 235 districts
has vitamin A supplementation coverage of 43 to 63 percent and these are distributed in the
states of Bihar, Uttar Pradesh, Madhya Pradesh, and some pockets of Jharkhand, Jammu and
Kashmir, Maharashtra, Odisha, Tamil Nadu, and Meghalaya. Most of the districts belonging
to West Bengal, Maharashtra, Gujarat, Jammu and Kashmir, Andhra Pradesh, Karnataka,
Kerala, Tripura have coverage of 64 to 84 percent, 30 districts in some pockets of Gujarat,
Karnataka, Kerala, Goa, Tamil Nadu Sikkim, Punjab, Haryana have very high coverage of
vitamin A supplementation ranging from 85 to 96 percent.

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 Figure 1. Distribution of vitamin A supplementation coverage gap in districts of India.

Spatial Clustering
To measure spatial autocorrelation, univariate local Moran’s I value has been computed for
vitamin A supplementation coverage in the districts of India. The Moran’s I statistics of 0.596
indicate moderate spatial autocorrelation but significantly positive spatial dependency in terms
of vitamin A supplementation coverage in India (Figure 2).

Figure 2 represents univariate LISA cluster and LISA significance map of vitamin A
supplementation coverage in districts of India. LISA cluster map showing 4 categories of
spatial dependency such as High-High (red color) cluster known as hot spots; Low-Low (blue
color) known as cold spots; High-Low and Low-High cluster known as outliers. Out of total
640 districts, 105 districts formed hot spots (High-High cluster) which indicate that these
districts with their neighbors have high vitamin A supplementation coverage. The hot spots are
mainly concentrated in the states of Gujarat, Maharashtra, Kerala, Karnataka, Tamil Nadu,

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Andhra Pradesh, Orrisa, Sikkim, Punjab and Haryana. A total of 121 districts have appeared
as cold spots (Low-Low cluster) which means these districts with their neighboring districts
have low vitamin A supplementation coverage. Cold spots are mainly concentrated in
Rajasthan, Uttar Pradesh, Nagaland, Arunachal Pradesh and Manipur. Total of 15 districts have
been found as outliers (either High-Low or Low-High cluster) in the vitamin A
supplementation coverage in India.

A B

Figure 2. Univariate LISA cluster map (A) and significance map (B) of vitamin A
supplementation coverage in India, 2015-16.
Descriptive Statistics
Table 1 represents that out of a total of 210350 samples, 58.46 percent of children aged 6 to
59 months have received vitamin A supplementation in India. Almost 41 percent among them
belong to aged 38 to 59 months; 38 percent and 48 percent among them belong to birth order
1 and 2-3 respectively; 52.2 percent and 48.2 percent are male and female respectively; almost
all the children live with their parents (99.9 percent); 30 percent of their mothers have no
education while almost 60 percent have attained secondary or less educational level; 45 percent
among them belong to OBC category; almost 72 percent live in rural areas, almost 46 percent
belong to the either poorest or poorer category.

Vitamin A Supplementation by Background Characteristics

Table 2 shows vitamin A supplementation among children aged 6 to 59 months by background
characteristics with Chi-square test statistics. Vitamin A supplementation among children was
considerably low in the age group 38 to 59 months (46.09 percent), 6 and above order of birth

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(60.69 percent) and children who live elsewhere (52.63 percent). The percentage of children
getting vitamin A supplementation was increased with increasing mother’s level of education,
mother’s mass media exposure and household wealth status. The rural-urban difference is
minimal and similar patterns were also found in caste and religious groups. All results were
statistically significant either 99.99 percent or 95 percent level of significance except the sex
of the child because girls and boys were almost equally likely to receive vitamin A
supplementation.

Association Between Vitamin A supplementation and Demographic and Socio-economic

Characteristics
Table 3 depicts the adjusted likelihood effect of various demographic and socio-economic
variables on vitamin A supplementation among children aged 6 to 59 months in India by using
multivariate logistic regression. Children aged 38 to 59 months were 17 percent (OR: 0.83; CI:
0.82 -0.85) less likely to receive vitamin A supplementation compare to children aged 6 to 26
months. Children born in higher birth order (6+) were 33 percent (OR: 0.67; CI: 0.64 - 0.70)
less likely to receive vitamin A compared to those born in 1st order of birth. Children whose
mothers were highly educated were 1.35 (OR: 1.35; CI: 1.30 - 1.40) times more likely to receive
vitamin A compared to illiterate mothers. Surprisingly, the likelihood of getting vitamin A
supplementation among caste group SC and ST were 11 percent (OR: 1.11; CI: 1.08 - 1.15)
and 19 percent (OR: 1.19; CI: 1.15 - 1.23) respectively higher compare to others. Among the
religious group Muslims and Christians had 18 percent (OR: 0.82; CI: 0.80 - 0.85) and 38
percent (OR: 0.62, CI: 0.59 - 0.64) lower odds of getting vitamin A compared to Hindus.
Interestingly, children who live in rural areas were 1.05 (OR: 1.05, CI: 1.03 - 1.08) times more
likely to get vitamin A supplementation compare to their urban counterparts. Children whose
mothers had exposure to any type of mass media were 29 percent (OR: 1.29; CI: 1.25 - 1.32)
more likely to receive vitamin A supplementation compare to children whose mothers were not
exposed to any kind of mass media. Children who were from richer (OR: 1.17; CI: 1.13 - 1.21)
and richest (OR: 1.16; CI: 1.12 - 1.21) households showed more likelihood of receiving vitamin
A supplementation compare to children who were belonged to the poorest household.

DISCUSSION: -
The present study shows the district level distribution and spatial heterogeneity of vitamin A
supplementation among children aged 6 to 59 months in India based on NFHS-4 data. It also
focused on the association of vitamin A supplementation with other demographic and socio-
economic variables.

According to the findings of the study, there is a significant variation in vitamin A

supplementation coverage across the districts of India. Out of 640 districts of India, 54 districts
had substantially low coverage of vitamin A supplementation coverage of less than 30 percent.
Even 180 districts have less than 50 percent coverage in vitamin A supplementation. It also
identified the spatial pattern and distribution of vitamin coverage across the districts. The
Moran's I statistic was positive, confirming the spatial dependence of full vaccination coverage
across Indian districts. A cold spot of around 121 districts was identified as a cluster of
disadvantaged districts. Most of them are belonging to Empowered Action Group (EAG) States
like Rajasthan, Uttar Pradesh, Uttarakhand, Madhya Pradesh, and the districts belonging to the

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North-Eastern states. The lack of coverage in these districts can be attributed to both demand
and supply-side concerns, such as a lack of awareness of the services’ perceived advantages,
acceptability of services, transportation issues, and poverty.

The findings of the study also revealed the importance of various contextual correlates in
determining the vitamin A supplementation coverage status of children in India. The study
discovered evidence of socioeconomic inequities and regional discrepancies in vitamin A
supplementation in India, which has been documented in several other Asian and African
research studies (Chai et al., 2005; Bendech et al., 2007; Grover et al., 2008; Semba et al.,
2008, 2010). Vitamin A supplementation among older children (aged 38-59 months) was
considerably low than the younger children (aged 6-26 months); supplementation decreased
with increasing birth order; had a strong positive association with mothers’ educational level
i.e., supplementation coverage increased with increasing educational level. In India, wealthier
households generally received more vitamin A supplementation than middle-class/poor
households, resulting in increased health disparities. However, no significant association had
been found in gender disparity of vitamin A supplementation among the children in India. The
evidence from this study is also supported by pieces of evidences from other studies (Bishai et
al., 2005; Agrawal and Agrawal, 2013; Srivastava and Kumar, 2021).
Vitamin A is a crucial vitamin for the immune system, as well as a wide range of metabolic
functions. It also helps to maintain epithelial tissue in the body. It also serves vital duties in
terms of disease prevention and promotion (Kapil and Sachdev, 2012). The World Health
Organization (WHO, 2011) recently released guidelines that provide global, evidence-based
advice on the use of vitamin A supplements to reduce morbidity and death. Vitamin A
supplementation in children aged 6 to 59 months is suggested in contexts where vitamin A
deficiency is a public health issue, according to these guidelines. Under the present, national
government policy a total of nine massive doses of synthetic vitamin A are to be given to all
children between the ages of 6 and 59 months irrespective of their socio-economic and
nutritional status to rapidly achieve universalized immunization coverage (Kapil and
Sachdev, 2012). But in the present situation, instead of continuing the universal massive
vitamin A supplementation program in India, it would be preferable to limit the massive dosage
of synthetic vitamin A to limited geographical pockets or locations (as shown in Figure 1.)
where clinical vitamin A deficiency is a substantial public health problem.

LIMITATION AND STRENGTH OF THE STUDY: -

This study also suffers from several limitations. It is based on a cross-sectional design, the
inherent problem with a cross-sectional design is that the outcome (vitamin A supplementation
status) and the exposure (in this case, demographic and socioeconomic characteristics) are
collected at the same time, making it sometimes difficult to draw causal conclusions. Second,
the interviewer gathered precise information on vitamin A supplementation of all the children
5 years prior to the study from their mothers or caregivers as part of the survey, which is less
trustworthy than vaccination cards due to recall bias. Although the interviewer checked the
child vaccination card for information on vitamin A supplementation in the field that did not
necessarily have the information on vitamin A doses. Third, the study did not go into detail on
why the children did not receive vitamin A supplementation. Fourth, this study was unable to

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investigate factors such as access and availability of services for vitamin A supplementation
coverage due to a lack of data. Like the other doses of the Universal Immunization Program
(UIP), access to health care and skilled human resources could potentially affect the rate of
vitamin A supplementation across the districts. Fifth, this study also lacks any spatial regression
analysis which could potentially be helpful a for better understanding of spatial heterogeneity.

Despite the limitation, huge nationally representative data with significant geographical,
regional, and district-wise differences is a strength of the present study. This study also reveals
spatial heterogeneity of vitamin A supplementation among children which was not done
previously to understand the coverage gap across the districts of India. The findings of the
study will also help the policymakers to identify and implement a target-based approach to
increase the coverage gap of vitamin A supplementation for children among the districts which
are lagging.

CONCLUSION: -
The present study gives an insight that can help to understand the spatial pattern and
distribution of vitamin A supplementation coverage among the children aged 6 to 59 months
across the districts of India. It also depicts spatial heterogeneity in terms of supplementation
coverage across the districts. Most of the districts which had very low coverage belonged to
EAG states and North-Eastern states and some pockets of Maharashtra, Odisha and Tamil
Nadu. It also examines the association of the outcome variable (vitamin A supplementation
among children aged 6 to 59 months) predictor variables (demographic and socioeconomic
characteristics). Vitamin A supplementation was negatively associated with child’s age in
month, birth order, and child lives elsewhere, while it was positively associated with mother’s
level of education, mother’s exposure to mass media and wealthy household. It is proposed that
mass vitamin A supplementation programs be conducted on a regional level with a target-based
approach, prioritizing states and districts with low social-economic development, in order to
boost overall vitamin A supplementation coverage and eliminate district-wise discrepancies.

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Kapil, U. (2002). Do we need campaign approach of vitamin A administration in non-vitamin

A deficient areas? Indian Journal of Pediatrics, 69(1), 39–40.
https://doi.org/10.1007/BF02723775

Kapil, U., & Sachdev, H. P. S. (2013). Massive dose vitamin A programme in India - Need for
a targeted approach. Indian Journal of Medical Research, 138(SEP), 411–417.

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Khan, J., Shil, A., & Mohanty, S. K. (2019). Hepatitis B vaccination coverage across India:
Exploring the spatial heterogeneity and contextual determinants. BMC Public Health,
19(1), 1–14. https://doi.org/10.1186/s12889-019-7534-2

Khan, J., Shil, A., & Prakash, R. (2018). Exploring the spatial heterogeneity in different doses
of vaccination coverage in India. PLoS ONE, 13(11), 1–20.
https://doi.org/10.1371/journal.pone.0207209

Mason, J. B., & Dalmiya, N. (2001). The Micronutrient Report.

MHFW, M. of H. and F. W. (2003). Policy on micronutrient vitamin A.

Nilima, Kamath, A., Shetty, K., Unnikrishnan, B., Kaushik, S., & Rai, S. N. (2018). Prevalence,
patterns, and predictors of diarrhea: A spatialoral comprehensive evaluation in India 11
Medical and Health Sciences 1117 Public Health and Health Services. BMC Public
Health, 18(1), 1–10. https://doi.org/10.1186/s12889-018-6213-z

Panda, B. K., Kumar, G., & Mishra, S. (2020). Understanding the full-immunization gap in
districts of India: a geospatial approach. Clinical Epidemiology and Global Health, 8(2),
536-543.

R.D., S., S., de P., K., S., N., A., M.W., B., V.K., R., Semba, R. D., de Pee, S., Sun, K., Akhter,
N., Bloem, M. W., & Raju, V. K. (2010). Coverage of vitamin A capsule programme in
Bangladesh and risk factors associated with non-receipt of vitamin A. Journal of Health,
Population, and Nutrition, 28(2), 143–148.

Rahaman, M., Rana, M. J., Roy, A., & Chouhan, P. (2022). Spatial heterogeneity and socio-
economic correlates of unmet need for spacing contraception in India: Evidences from
National Family Health Survey, 2015-16. Clinical Epidemiology and Global Health,
15(September 2021), 101012. https://doi.org/10.1016/j.cegh.2022.101012

Reddy, G. B., Pullakhandam, R., Ghosh, S., Boiroju, N. K., Tattari, S., Laxmaiah, A.,
Hemalatha, R., Kapil, U., Sachdev, H. S., & Kurpad, A. V. (2021). Vitamin A deficiency
among children younger than 5 y in India: An analysis of national data sets to reflect on
the need for vitamin A supplementation. American Journal of Clinical Nutrition, 113(4),
939–947. https://doi.org/10.1093/ajcn/nqaa314

Semba, R. D., de Pee, S., Sun, K., Bloem, M. W., & Raju, V. K. (2008). Coverage of the
national vitamin A supplementation program in Ethiopia. Journal of Tropical Pediatrics,
54(2), 141–144. https://doi.org/10.1093/tropej/fmm095

Srivastava, S., & Kumar, S. (2021). Does socio-economic inequality exist in micro-nutrients
supplementation among children aged 6–59 months in India? Evidence from National
Family Health Survey 2005–06 and 2015–16. BMC Public Health, 21(1), 1–12.
https://doi.org/10.1186/s12889-021-10601-6

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Wahl, B., Gupta, M., Erchick, D. J., Patenaude, B. N., Holroyd, T. A., Sauer, M., Blunt, M.,
Santosham, M., & Limaye, R. J. (2021). Change in full immunization inequalities in
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World Health Organization. (2011). Guideline: Vitamin A supplementation in infants and

children 6 – 59 months of age. World Health Organization, 1–25.

Table 1: Percent distribution of children aged 6 to 59 months by selected background

characteristics in India, 2015-2016

Background
n = 210350 Percent (weighted)
Characteristics
Vitamin A in last 6
months
No 94,329 41.54
Yes 1,16,021 58.46
Child's age in months
6-26 81,893 38.97
27-37 42,578 20.23
38-59 85,879 40.81
Birth Order
1 77,506 38.37
2-3 98,967 47.57
4-5 25,258 10.58
6+ 8619.00 3.48
Sex of Child
Male 1,09,436 52.20
Female 1,00,914 47.80
Child lives with whom
Respondent 2,10,160 99.91
Lives elsewhere 190 0.09
Mother's Education
No education 65,515 30.07
Primary or less 30,747 13.98
Secondary or less 94,353 45.31
Higher 19,735 10.63
Caste
ST 43,421 22.3
SC 41,244 10.69
OBC 85,988 45.76
Others 39,697 21.25
Religion
Hindu 1,55,950 80.34
Muslim 28,251 14.72
Christian 17,637 2.08
others 6,038 2.87

17 | P a g e
Place of Residence
Urban 50,893 28.52
Rural 1,59,457 71.48
Mass media exposure
No 57,982 26.39
Yes 1,52,368 73.61
Wealth Quintiles
Poorest 55,205 24.96
Poorer 48,808 21.59
Middle 41,886.00 19.86
Richer 35,372.00 18.50
Richest 29,079.00 15.09

Table 2: Pattern of received vitamin A supplementation among children aged 6 to 59

months by selected background characteristics in India, 2015-16

Received Vitamin A in last Chi2

6 months Significance
Characteristics(n=210350) Significance
level
No Yes Test
Child's age in months
6-26 42.47 57.53 Pr = 0.000 p <0.001
27-37 42.23 57.77
38-59 46.09 53.91
Birth Order
1 42.04 57.96 Pr = 0.000 p <0.001
2-3 43.99 56.01
4-5 51.42 48.58
6+ 60.69 39.31
Sex of Child
Not
Male 44.75 55.25 Pr = 0.360 Significant
Female 44.95 55.05
Child lives with whom
Respondent 44.84 55.16 Pr = 0.031 p <0.05
Lives elsewhere 52.63 47.37
Mother's Education
No education 52.05 47.95 Pr = 0.000 p <0.001
Primary or less 47.59 52.41
Secondary or less 40.45 59.55
Higher 37.65 62.35
Caste
ST 46.95 53.05 Pr = 0.000 p <0.001
SC 43.56 56.44
OBC 44.78 55.22
Others 44.01 55.99
Religion
Hindu 43.17 56.83 Pr = 0.000 p <0.001

18 | P a g e
 Muslim 50.73 49.27
Christian 52.53 47.47
others 40 60
Place of Residence
Urban 42.48 57.52 Pr = 0.000 p <0.001
Rural 45.6 54.4
Mass media exposure
No 53.03 46.97 Pr = 0.000 p <0.001
Yes 41.73 58.27
Wealth Quintiles
poorest 50.13 49.87 Pr = 0.000 p <0.001
poorer 47.79 52.21
middle 43.3 56.7
richer 39.46 60.54
richest 38.63 61.37

Table 3: Likelihood estimates of received vitamin A supplementation among children

aged 6 to 59 months by selected background characteristics in India, 2015-16

Vitamin A Odds Significance [95 percent Conf.

Supplementation Ratio Level Interval]
Child's age in months
6-26 a 1
27-37 0.95 0.000 [0.92 - 0.97]
38-59 0.83 0.000 [0.82 - 0.85]

Birth Order
1a 1
2-3 0.995 0.631 [0.98 - 1.01]
4-5 0.87 0.000 [0.85 - 0.90]
6+ 0.67 0.000 [0.64 - 0.70]
Child lives with whom
Mothersa 1
Lives elsewhere 0.74 0.038 [0.55 - 0.98]
Mother's education
No educationa 1
Primary or less 1.09 0.000 [1.06 - 1.13]
Secondary or less 1.31 0.000 [1.28 - 1.34]
Higher 1.35 0.000 [1.30 - 1.40]
Caste
Othersa 1
SC 1.11 0.000 [1.08 - 1.15]
ST 1.19 0.000 [1.15 - 1.23]
OBC 1.05 0.000 [1.03 - 1.08]
Religion

19 | P a g e
 Hindua 1
Muslim 0.82 0.000 [0.80 - 0.85]
Christian 0.62 0.000 [0.59 - 0.64]
others 1.03 0.278 [0.98 - 1.07]
Place of Residence
Urbana 1
Rural 1.05 0.000 [1.03 - 1.08]
Mass Media Exposure
Noa 1
Yes 1.29 0.000 [1.25 - 1.32]
Wealth Quintiles
Pooresta 1
Poorer 0.96 0.003 [0.94 - 0.99]
Middle 1.05 0.004 [1.01 - 1.08]
Richer 1.17 0.000 [1.13 - 1.21]
Richest 1.16 0.000 [1.12 - 1.21]

adenotes the reference category

Table 4: District-wise vitamin A supplementation coverage among children aged 6 to 59

months in India, 2015-16

Vitamin A Vitamin A
State District Supplementati State District Supplementati
on (percent) on (percent)

Kupwara 68.71 Darjiling 40.69

Badgam 60.16 Jalpaiguri 66.29

Leh 65.77 Koch Bihar 67.91

Jammu And Kashmir

Kargil 69.86 Uttar Dinajpur 59.68

West Bengal

Punch 83.45 Dakshin Dinajpur 75.56

Rajouri 63.55 Maldah 48.39

Kathua 41.82 Murshidabad 58.33

Baramula 95.17 Birbhum 64.13

Bandipore 63.72 Barddhaman 62.18

Srinagar 74.84 Nadia 65.32

20 | P a g e
 North Twenty
Ganderbal 60.65 51.09
Four Par

Pulwama 61.48 Hugli 66.56

Shupiyan 38.55 Bankura 73.45

Anantnag 49.91 Puruliya 67.83

Kulgam 57.16 Haora 67.14

Doda 59.98 Kolkata 60.3

South Twenty
Ramban 85.28 66.58
Four Par

Paschim
Kishtwar 76.15 68.93
Medinipur

Udhampur 45.66 Purba Medinipur 67.77

Reasi 71.62 Garhwa 47.21

Jammu 49.18 Chatra 55.69

Samba 37.03 Kodarma 49.26

Chamba 50.96 Giridih 64.82

Kangra 64.46 Deoghar 41.28
Lahul And
52.99 Godda 47.45
Spiti

Kullu 59.28 Sahibganj 48.31

Jharkhand
Himachal Pradesh

Mandi 67.67 Pakur 62.76

Hamirpur 81.68 Dhanbad 48.12

Una 69.15 Bokaro 48.17

Bilaspur 77.44 Lohardaga 58.91

Solan 57.44 Purbi Singhbhum 45.65

Sirmaur 61.64 Palamu 48.89

Shimla 51.95 Latehar 53.81

21 | P a g e
 Kinnaur 61.5 Hazaribagh 69.49

Gurdaspur 79.9 Ramgarh 48.66

Kapurthala 89.73 Dumka 47.89

Jalandhar 85.63 Jamtara 44.69

Hoshiarpur 65.41 Ranchi 54.08

Sangrur 70.41 Khunti 63.16

Fatehgarh
76.15 Gumla 68.09
Sahib

Ludhiana 41.73 Simdega 54.89

Pashchimi
Moga 83.3 36.04
Singhbhum
Saraikela
Firozpur 64.18 54.09
Kharsawan
Muktsar 75.4 Bargarh 67.78
Punjab

Faridkot 92.23 Jharsuguda 71.69

Bathinda 67.99 Sambalpur 51.95

Mansa 55.02 Debagarh 70.05

Patiala 73.01 Sundargarh 64.83

Amritsar 57.42 Kendujhar 71.62

Orissa

Tarn Taran 75.06 Mayurbhanj 77.79

Rupnagar 65.06 Baleshwar 62.07

Sahibzada Ajit
54.72 Bhadrak 76.47
Singh

Shahid Bhagat
57.35 Kendrapara 58.03
Singh N

Barnala 78.67 Jagatsinghapur 85.15

22 | P a g e
 Chandigarh 49.26 Cuttack 79.5

Uttarkashi 28.67 Jajapur 75.83

Chamoli 39.38 Dhenkanal 63.83

Rudraprayag 47.16 Anugul 62.44

Tehri Garhwal 25.25 Nayagarh 81.09

Dehradun 35.06 Khordha 75.91

Chandigarh

Garhwal 37.31 Puri 82.34

Pithoragarh 45.13 Ganjam 51.46

Bageshwar 31.36 Gajapati 50.85

Almora 51.28 Kandhamal 78.57

Champawat 36.91 Baudh 60.54

Nainital 48.16 Subarnapur 76.05

Udham Singh
40.17 Balangir 50.4
Nagar

Hardwar 27.49 Nuapada 57.46

Panchkula 70.51 Kalahandi 76.63

Ambala 77.37 Rayagada 70.78

Yamunanagar 53.57 Nabarangapur 75.3

Haryana

Kurukshetra 81.16 Koraput 55.26

Kaithal 79.42 Malkangiri 64.53

Chhattisgarh

Karnal 79.37 Korea (Koriya) 74.07

Panipat 72.86 Surguja 61.82

Sonipat 81.45 Jashpur 61.25
Jind 72.1 Raigarh 76.04

23 | P a g e
 Fatehabad 64.38 Korba 62.78

Sirsa 60.82 Janjgir - Champa 59.15

Hisar 89.78 Bilaspur 77.24

Bhiwani 64.98 Kabirdham 73.01

Rohtak 62.34 Rajnandgaon 75.55

Jhajjar 77.82 Durg 71.17

Mahendragarh 85.24 Raipur 69.06

Rewari 56.08 Mahasamund 56.78

Gurgaon 69.39 Dhamtari 59.48

Uttar Bastar
Mewat 23.62 69.49
Kanker

Faridabad 54.89 Bastar 65.93

Palwal 44.31 Narayanpur 72.1

Dakshin Bastar
North West 58.26 64.97
Dantew

North 59.11 Bijapur 78.36

North East 53.36 Sheopur 56.57

East 58.19 Morena 53.46

NCT Of
Delhi New Delhi 51.81 Bhind 54.25
Madhya Pradesh

Central 55.71 Gwalior 63.67

West 50.63 Datia 41.15

South West 75.23 Shivpuri 53.57

South 44.72 Tikamgarh 55.08

Rajasthan

Ganganagar 56 Chhatarpur 54.29

Hanumangarh 44.71 Panna 49.39

24 | P a g e
 Bikaner 25.42 Sagar 49.86
Churu 34.52 Damoh 46.71

Jhunjhunun 55.51 Satna 63.92

Alwar 42.89 Rewa 61

Bharatpur 36.73 Umaria 59.83

Dhaulpur 44.47 Neemuch 64.54

Karauli 39.12 Mandsaur 52.25

Sawai
38.66 Ratlam 67.52
Madhopur

Dausa 28.63 Ujjain 73.43

Jaipur 47.79 Shajapur 45.07
Sikar 43.36 Dewas 64.39
Nagaur 48.04 Dhar 67.85
Jodhpur 46.54 Indore 59.27

Khargone (West
Jaisalmer 23.46 78.34
Nimar)

Barmer 22.81 Barwani 50.94

Jalor 38.62 Rajgarh 46.33
Sirohi 31.85 Vidisha 42.92
Pali 29.69 Bhopal 49.33
Ajmer 24.32 Sehore 63.02
Tonk 39.26 Raisen 71.42
Bundi 41.09 Betul 72.95

Bhilwara 43.83 Harda 70.87

Rajsamand 15.88 Hoshangabad 69.75

Dungarpur 14.48 Katni 66.78

Banswara 45.92 Jabalpur 67.91

Chittaurgarh 40.33 Narsimhapur 63.99

Kota 36.6 Dindori 57.43

Baran 60.64 Mandla 66.8

25 | P a g e
 Jhalawar 61.47 Chhindwara 68.9

Udaipur 32.27 Seoni 65.27

Pratapgarh 54.3 Balaghat 63.28

Saharanpur 40.11 Guna 59.14

Muzaffarnagar 15.88 Ashoknagar 61.6

Bijnor 41.59 Shahdol 52.82

Moradabad 30.2 Anuppur 65.19

Rampur 41.72 Sidhi 46.13

Jyotiba Phule
45.95 Singrauli 51.65
Nagar

Meerut 24.12 Jhabua 50.17

Baghpat 38.94 Alirajpur 55.96

Khandwa (East
Ghaziabad 33.26 75.9
Nimar)
Uttar Pradesh

Gautam
27.27 Burhanpur 54.82
Buddha Nagar

Bulandshahr 44.73 Kachchh 68.05

Aligarh 19.01 Banaskantha 56.95

Mahamaya
22.16 Patan 72.64
Nagar

Mathura 30.94 Mahesana 68.05

Gujarat

Agra 31.94 Sabarkantha 62.59

Firozabad 34.75 Gandhinagar 59

Mainpuri 33.59 Ahmadabad 57.81

Budaun 31.59 Surendranagar 81.92

Bareilly 16.38 Rajkot 70.22

26 | P a g e
 Pilibhit 20.68 Jamnagar 70.03

Shahjahanpur 28.75 Porbandar 89.46

Kheri 38.8 Junagadh 82.68

Sitapur 39.63 Amreli 85.72

Hardoi 59.39 Bhavnagar 89.89

Unnao 42.24 Anand 77.16

Lucknow 36.63 Kheda 73.01

Rae Bareli 38.81 Panchmahal 66.99

Farrukhabad 22.29 Dohad 77.42

Kannauj 34.78 Vadodara 68.72

Etawah 30.25 Narmada 68.37

Auraiya 43.3 Bharuch 73.15

Kanpur Dehat 50.28 The Dangs 72.18

Kanpur Nagar 29.54 Navsari 73.16

Jalaun 37.52 Valsad 84.78

Jhansi 44.36 Surat 81.17
Lalitpur 54.84 Tapi 81.67

Hamirpur 61.39 Daman And Diu 76.79

Diu
Mahoba 43.26 Daman 72.89

Dadra &
Dadra & Nagar
Banda 26.21 Nagar 59.26
Haveli
Haveli

Chitrakoot 43.03 Nandurbar 70.58

Maharashtra

Fatehpur 33.6 Dhule 79.72

Pratapgarh 46.28 Jalgaon 57.92

Kaushambi 39.24 Buldana 62.55

27 | P a g e
Allahabad 54.42 Akola 70.54

Bara Banki 44.78 Washim 66.46

Faizabad 38.06 Amravati 73.21

Ambedkar
37.39 Wardha 76.87
Nagar

Sultanpur 47.55 Nagpur 76.29

Bahraich 18.01 Bhandara 65.32

Shrawasti 28.75 Gondiya 74.44

Balrampur 34.47 Gadchiroli 69.42

Gonda 39.53 Chandrapur 70.44

Siddharth
44.76 Yavatmal 77.36
Nagar
Basti 54.72 Nanded 61.58

Sant Kabir
42.32 Hingoli 59.61
Nagar

Mahrajganj 57.84 Parbhani 66.38

Gorakhpur 56.18 Jalna 65.39

Kushinagar 61.03 Aurangabad 78.61

Deoria 50.89 Nashik 63.2

Azamgarh 38.43 Thane 64.71

Mumbai
Mau 27.15 81.97
Suburban

Ballia 30.43 Mumbai 78.39

Jaunpur 37.88 Raigarh 66.17

Ghazipur 47.13 Pune 59.9

Chandauli 63.7 Ahmadnagar 74.17

28 | P a g e
 Varanasi 43.49 Bid 77.87

Sant Ravidas
28.58 Latur 59.73
Nagar (B

Mirzapur 51.48 Osmanabad 62.3

Sonbhadra 54.14 Solapur 61.17

Etah 31.94 Satara 56.75

Kanshiram
23.63 Ratnagiri 72.73
Nagar

Pashchim
58.28 Sindhudurg 81.17
Champaran
Purba
46.15 Kolhapur 69.51
Champaran
Sheohar 47.46 Sangli 63.8
Sitamarhi 56.44 Adilabad 73.95
Madhubani 61.37 Nizamabad 73.62
Supaul 71.18 Karimnagar 71.76
Araria 60.32 Medak 74.27
Telengana

Kishanganj 69.56 Hyderabad 72.65

Purnia 69.8 Rangareddy 70.14

Katihar 63.23 Mahbubnagar 74.1

Bihar

Madhepura 53.41 Nalgonda 79.55

Saharsa 55.8 Warangal 88.63

Darbhanga 69.38 Khammam 80.11

Muzaffarpur 56.36 Srikakulam 89.34

Gopalganj 65.05 Vizianagaram 78.26

Andhra Pradesh

Siwan 69.7 Visakhapatnam 60.41

Saran 59.41 East Godavari 79.06

Vaishali 73.25 West Godavari 73.11

Samastipur 59.86 Krishna 53.61

Begusarai 64.68 Guntur 84.39

Khagaria 64.99 Prakasam 70.21

29 | P a g e
 Sri Potti
Bhagalpur 74.08 62.53
Sriramulu N
Banka 62.12 Y.S.R. 80.61
Munger 64.71 Kurnool 72.49
Lakhisarai 59.29 Anantapur 56.85

Sheikhpura 59.68 Chittoor 72.37

Nalanda 56.8 Belgaum 83.13

Patna 52.34 Bagalkot 90.07
Bhojpur 65.32 Bijapur 59.59
Buxar 62.91 Bidar 68.57

Kaimur
47.3 Raichur 66.68
(Bhabua)

Rohtas 56.42 Koppal 88.76

Aurangabad 57.43 Gadag 80.87
Gaya 60.53 Dharwad 72.04
Nawada 54.16 Uttara Kannada 74.11
Jamui 48.83 Haveri 91.2
Jehanabad 55.86 Bellary 76.62

Arwal 57.22 Chitradurga 71.24

Karanataka

North District 88.65 Davanagere 85.18

West District 76.26 Shimoga 68.73

Skkim
South District 85.84 Udupi 78.27

East District 81.06 Chikmagalur 87.14

Tawang 36.89 Tumkur 66.71

West Kameng 43.85 Bangalore 68.92

Arunachal Pradesh

East Kameng 20.82 Mandya 87.67

Papumpare 53.64 Hassan 77.8

Upper Dakshina
55.34 71.71
Subansiri Kannada
West Siang 49.61 Kodagu 82.44
East Siang 62.77 Mysore 71.97

30 | P a g e
 Upper Siang 52.73 Chamarajanagar 88.99

Changlang 27.74 Gulbarga 86.29

Tirap 21.68 Yadgir 77.14

Lower
47.91 Kolar 94.06
Subansiri

Kurung
25.7 Chikkaballapura 77.46
Kumey

Dibang Valley 27.41 Bangalore Rural 86.65

Lower Dibang
55.18 Ramanagara 90.11
Valley

Lohit 39.43 North Goa 91.7

Goa
Anjaw 51.37 South Goa 82.19
Lakshadwe
Mon 13.25 Lakshadweep 52.27
ep
Mokokchung 56.13 Kasaragod 62.7

Zunheboto 20.31 Kannur 65.5

Wokha 29.12 Wayanad 66.55
Nagaland

Dimapur 39.74 Kozhikode 62.4

Phek 17.57 Malappuram 63.04
Tuensang 20.92 Palakkad 65.65
Longleng 12.15 Thrissur 72.4
Kerala

Kiphire 20.17 Ernakulam 70.18

Kohima 37.4 Idukki 84.79
Peren 29.82 Kottayam 76.42
Senapati
16.12 Alappuzha 84.52
(Excluding 3
Tamenglong 21.96 Pathanamthitta 80.76
Churachandpu
Manipur

17.77 Kollam 91.02

r
Thiruvananthapur
Bishnupur 28.59 83.8
am
Tamil Nadu

Thoubal 29.36 Thiruvallur 60.95

Imphal West 51.54 Chennai 56.56
Imphal East 29.21 Kancheepuram 65

31 | P a g e
 Ukhrul 12.65 Vellore 72.88
Chandel 13.93 Tiruvannamalai 85.55
Mamit 60.41 Viluppuram 64.96
Kolasib 73.31 Salem 67.63

Aizawl 74.5 Namakkal 59.25

Mizoram

Champhai 75.81 Erode 62.02

Serchhip 72.46 The Nilgiris 80.47

Lunglei 64.84 Dindigul 62.27

Lawngtlai 44.29 Karur 75.01

Saiha 68.93 Tiruchirappalli 68.21

West Tripura 68.89 Perambalur 65.56

South Tripura 67.01 Ariyalur 78.2

Tripura
Dhalai 54.52 Cuddalore 57.62

North Tripura 43.6 Nagapattinam 63.61

West Garo
62.29 Thiruvarur 67.79
Hills
East Garo
52.32 Thanjavur 67.83
Hills
South Garo
74.08 Pudukkottai 66.91
Meghala Hills
ya West Khasi
37.48 Sivaganga 59.73
Hills
Ribhoi 58.19 Madurai 59.76
East Khasi
57.75 Theni 80.91
Hills
Jaintia Hills 47.79 Virudhunagar 79.18

Kokrajhar 27.53 Ramanathapuram 58.95

Dhubri 37.01 Thoothukkudi 64.65

Goalpara 60.12 Tirunelveli 62.82

Assam

Barpeta 48.1 Kanniyakumari 59.92

Morigaon 41.33 Dharmapuri 80.15

Nagaon 41.6 Krishnagiri 63.63
Sonitpur 54.86 Coimbatore 61.27
Lakhimpur 46.18 Tiruppur 87.67

32 | P a g e
 Dhemaji 43.92 Yanam 64.76
Tinsukia 60.44 Puducherry 71.01
Puducherry
Dibrugarh 66 Mahe 72.79

Sivasagar 53.02 Karaikal 68.85

Jorhat 50.07 Nicobars 66.21

Andaman
& Nicobar North & Middle
Golaghat 63.01 53.49
Island Andaman
Karbi Anglong 36.77 South Andaman 63.99
Dima Hasao 39.16
Cachar 59.21
Karimganj 66.71

Hailakandi 69.53

Bongaigaon 52.07

Chirang 40.02
Kamrup 59.17
Kamrup
62.33
Metropolitan
Nalbari 42.59
Baksa 51.57
Darrang 54.16
Udalguri 67.47

33 | P a g e