INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

[Development of composite] | Venkaiah K et al

ORIGINAL ARTICLE

Development of composite index and ranking the districts using nutrition survey data
in Madhya Pradesh, India
Venkaiah Kodavalla., Indrapal Ishwarji Meshram, Manohar Gottimukkula., Mallikharjun Rao Kodavanti,
SreeRamakrisha Kakani, Laxmaiah Avula.
National Institute of Nutrition, ICMR, Hyderabad
Abstract

Introduction

Methodology

Results

Conclusion

References

Citation

Tables / Figures

Corresponding Author
Address for Correspondence: Indrapal I. Meshram, National Institute of Nutrition, ICMR, Hyderabad
E Mail ID: [email protected]

Citation
Venkaiah K., Meshram I. I., Manohar G., Mallikharjun Rao K., SreeRamakrisha K., Laxmaiah A. Development of
composite index and ranking the districts using nutrition survey data in Madhya Pradesh, India. Indian J
Comm Health. 2015; 27, 2: 204-210.
Source of Funding : Women and Child Development & Social Justice Department, Ministry of Health & family
Welfare, Government of Madhya Pradesh, India; Conflict of Interest: None declared

Article Cycle
Submission: 18/03/2015; Revision: 01/06/2015; Acceptance: 18/06/2015; Publication: 30/06/2015

Abstract
Introduction: Level of development in health and nutrition at district level is useful for planning intervention in
less developed districts. Aims & Objectives: To develop composite index based on 12 variables to compare
development within districts in the state of Madhya Pradesh. Material & Methods: Data collected by National
Institute of Nutrition, Hyderabad during 2010-11 on nutritional status of rural children at district level in Madhya
Pradesh was used. A total of 22,895 children (Boys: 12379, Girls: 10516), were covered. Results: It was observed
that Indore district rank 1st as per composite index and Singrauli rank last in the district ranking. Three categories
of districts were done based on percentile of composite index i.e less developed, developing and developed
districts. It was observed that there was significant (p<0.01) trend in the prevalence of undernutrition among
three set of districts. Similarly, significant (p<0.01) trend was observed in proportion of children participating
regularly in ICDS supplementary feeding programme, use of sanitary latrine and iodized cooking salt among three
sets of districts. Conclusions: Widespread disparity in health and nutrition was observed among the districts. It is
quite important to examine the extent of improvements needed in different developmental indicators for
enhancing the level of development of low developed districts. This will help the planners and administrators to
readjust the resources for bringing about uniform development in the state.

Key Words
Composite index; ranking of districts; nutritional status; Madhya Pradesh
countries with other areas where it stands in
Introduction
comparison with others. Per Capita Gross Domestic
In recent years, international organizations, thinkProduct (GDP) is a measure which provides a more
tanks, and academicians in the quantitative social
intuitive understanding of the states economy, than
sciences have been bringing out many composite
a table of the output of different industries and
indices designed to assess broad social science
sectors and it provides a single estimate. Composite
concepts in concise manner (1). The composite
indices have substantial ease of interpretation over
indices have the ability to summarize complex or
the use of multiple indicators benchmarks, while
multi-dimensional issues in a simple manner, making
quantification of a concept makes it possible to
it possible for policymakers to get a perceptible and
monitor progress over a period and to highlight cases
representative sense of the situation in a given
where intervention may be needed (2).
geographical area, which enable to compare
204

INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

The Human Development Index (HDI) is a composite

measure of health, education and income. This index
was first introduced in Human development Report
in 1990 as an alternative to GDP to assess National
progress in a specified period (3-5).
HDI is a summary measure of average achievement
in key dimensions of human development; i.e. a long
and healthy life, being knowledgeable and have a
decent standard of living. The standard of living is
measured by gross per capita national income. The
HDI does not reflect about inequalities, poverty,
human security and empowerment. etc. (3-5).
United Nations annually ranks all the member
countries on the basis of health, education and
income. The human development index reveals the
relative rank of a countrys achievement in a concise
manner. This helps to identify the countries of
immediate concerns as well as prioritize the relevant
policy areas. National level figure of the HDI has its
own limitations in the policy formulation, especially,
for a large country like India where socio-cultural,
demographic and socio-economic status is diverse.
To minimize such limitations, it needs to adopt a
measure that can capture the said disparities in
aspects of human wellbeing where appropriate
policy actions can be focused at the level of the
smallest possible administrative unit. The 73rd and
74th amendments (6) of the constitution
emphasized the need of decentralization and the
focus for planning and programme implementation
at district level.
Composite index techniques were also used to
classify districts based on agriculture development in
different states (7-8).
In backdrop of this, the assessment of the current
status of development at district level is essential, as
the districts vary considerably in the achievement of
socio-demographic, health, social status and
development of infrastructure. Therefore, ranking
and mapping of the districts on the basis of the
selected developmental indicators will help to
identify the districts with their relative performance
and also to know the districts performing well and
which are lagging behind in the State, so that
appropriate strategies can be developed and
implemented in focussed way in the resource
constraint set up in country like India.

[Development of composite] | Venkaiah K et al

Pradesh by using various health and nutrition

indicators and to compare with the ranks given to
the districts by IIPS in 2006 for Madhya Pradesh (9).

Material and Methods

The data on health and nutrition carried out during
2010-11 in Madhya Pradesh was utilized, which was
collected by National Institute of Nutrition (NIN),
Hyderabad during 2010 in all the districts Madhya
Pradesh [10] and secondary data from Census 2011
[11] and Annual health survey 2011-12 for Madhya
Pradesh were utilized [12].
The study was approved by Institutional Ethical
Review Board and consent was obtained from the
mothers of children involved in the study.
Selection of Indicators: An selection of appropriate
indicators /variables itself is first important step for
ranking and categorizing the districts to decide the
relative rank of district with regard to development
in terms of health and nutrition as compared to
other districts in the state. The following 12
indicators were identified and used for calculating
the composite Index. Methodology adopted earlier
in 2006 by Indian Institute of Population Studies
(IIPS), Mumbai for relative measurement of districts
in Madhya Pradesh state was used in this
presentation (9).
The following variables were selected to compute
the relative ranking for each district.
1. Female Literacy Rate (%) Respondent is the
mother of index child.
2. Children (12-24 months) fully immunized (%)
3. Household access to safe drinking water (%)
4. Household having toilet facility and in use (%)
5. Household with Electricity (%)
6. Pregnant women received 2 doses of TT injections
during pregnancy (%) Respondent is the mother
of index child.
7. Pregnant women who had 3 or more ANCs (%)
Respondent is the mother of index child.
8. Children with birth order 3 (%)
9. A woman with maternal age < 18 years (%) at the
time of marriage Respondent is the mother of
index child.
10. Prevalence (%) of underweight among < 5 years
children.
11. Population <5 years (%) - Census 2011.
12. Under 5 mortality rate (%) - Annual health survey
2011-12
Statistical analysis: The procedure adopted by
Iyengar and Sudarshan (1982) [13] to classify regions

Aims & Objectives

To rank the districts on the basis of selected
developmental indicators in the State of Madhya
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

using multivariate data to measure development in

India, and is widely used to provide a composite
index for spatial differentiation in the level of
development. Present analysis was also carried out
in similar way to calculate the index value for a given
development indicator and the composite index
value for each district, as follows;
Let Xi represent the value of the I-th variable and is
positively associated with development of district,
then
(Xi) Min (Xi)
Index Value (Xi) = ------------------------------------ I
Max (Xi) Min (Xi)
For e.g. the higher the female literacy rate, better is
the district.
If Xi is negatively associated with development of
district, then
Max (Xi) (Xi)
Index Value (Xi) = ----------------------------------------- II
Max (Xi) Min (Xi)
For e.g., Percentage of non-immunized & partially
immunized children are low, better is the district.
The composite index is the simple average of all the
indices. It may possible that among the selected
indicators, one is more important than the other,
and therefore, for the composite index, there is a
need to give appropriate weights to each of the
Indicator. However, we have opted for a simple
average to construct the composite index.

[Development of composite] | Venkaiah K et al

It
facilitates
the
task
of
ranking
states/districts/regions etc. on complex issues.
It can assess the progress of different regions over
time.
It reduces the size of a set of indicators or includes
more information within the existing size limit.
It places performance and progress of different
regions at the centre of policy arena.
It facilitates communication with general public
(citizen, media etc.) and promotes accountability
Disadvantages
It may send misleading policy messages if it is
poorly constructed.
It may invite simplistic policy conclusions which
may not be possible for adoption.
It may be misused.
The selection of indicators and weights for
aggregating the composite index can change the final
conclusions.
It may lead to inappropriate conclusions if
indicators that are difficult to measure, are ignored
The back-ground characteristics of the districts were
tabulated and tested for the significant difference
between groups using Chi-square statistic

Results
The descriptive statistics (minimum, maximum and
average percentage) of various parameters included
in the analysis are presented in Table-I. About a third
of children interviewed, the birth order was three
and above. A maximum of 100% of the children in a
district were fully immunized with an average of
84.5%.
The average female literacy is about 48% with a
minimum of 13% and maximum of 79%. Majority of
HHs (81.04%) were using safe drinking water (bore
well and tap), while, the usage of toilet facility was
poor (12.12%). About three fourth of the HHs
surveyed had the electricity facility. Health
parameters such as ANC visits and TT injections were
satisfactory. The prevalence of underweight ranged
from a minimum of 35% to maximum of 67% in the
state (Table 1).

Composite Index (CI) = (X1+X2+X3+. +X12)/12

------------- III
After the calculations, the values were arranged in
ascending order accordingly. Higher the value, better
the rank, second highest will be second rank,
similarly, the last value will get the last rank. The
Percentiles was calculated and used to classify the
districts. The index values up to 25th Percentile has
been considered in the category of least developed
districts. The districts having the composite index
value between 25th and 75th percentile are
considered as developing districts. Finally, districts
with composite index value above 75th percentile
are grouped under more developed districts.

The Composite Index was developed and values

were divided on the basis of percentiles as presented
below. Composite index value and the relative rank
of the district are presented in table 2a, 2b &2c.
Indore district has the highest relative ranking of 1 as
compared to other districts and district Singrauli is
the lowest in rankings.

Advantages of composite index

It can summarize complex or multi-dimensional
issues.
It is easier to interpret.
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

0.3209 to 0.5070

Under
Developed
Districts (12)

25th Percentile= 0.5162

0.5193 to 0.6878

Developing
Districts (26)

75th Percentile = 0.6904

0.6980 to 0.7880

[Development of composite] | Venkaiah K et al

An attempt was made to construct composite index

using the primary data carried out by the Institute.
This cumulative index helps to categorize the
districts in different levels of development.
The analyses showed that 12 districts were less
developed, 26 were developing and remaining 12
were developed as per composite index values.
Nearly 80% of the districts, the ranks given by the
two surveys are similar. The improvement in ranking
of districts from 2006 IIPS survey might be the time
interval of 5-6 years duration during which many
nutritional interventional programmes took place in
Madhya Pradesh. The districts which are still in under
developed category mostly belong to tribal region
where intensification of intervention strategies is
needed to improve the health and nutritional status.
The findings of the present study are similar to the
study by IIPS in ranking of districts in Madhya
Pradesh [9).
Cholakkal (2013) in his study in Kerala also used
similar method to classify districts according to
development in health and education (14).
Narain et al (2002) (8) report on socioeconomic
development in Madhya Pradesh reported that 10
districts were high level of development, 27 in
middle level of development and 8 districts in low
level of development which is in accordance with our
results (15).
It is quite useful and important to examine the extent
of improvements needed in different developmental
indicators for enhancing the level of development of
low developed districts. This will help the planners
and administrators to readjust the resources for
bringing about uniform regional development.
Indore is known as a commercial capital of Madhya
Pradesh, and is one of the richest cities in central
India and also known as "Mini Mumbai. Average
literacy rate was 82% in Indore district in 2011 with
87.2% and 74.0% among male and female
respectively, while in Singrauli, literacy rate was
73.7% and 49.8% among men & women respectively.
Infant mortality was 74 per 1000 live birth in rural
areas of Singrauli, while it was 34 per 1000 in rural
areas of Indore (16), sanitary latrine was available in
67% in rural areas of Indore, while it was 2.3% in
Singrauli (17).
The strength of the study is that the 10 variables
included in composite index were from the primary
data carried out by NIN in Madhya Pradesh, and the
data collection was done by the qualified
investigators trained by NIN scientists and

Composite Index

More
Developed
Districts (12)

12 districts were observed to be below 25th

percentile Score of 0.5162, 26 districts were
between 25th to 75th percentile score between
0.5193 to 0.904 and only 12 districts were above
75th percentile score of 0.6904. Indore district
ranked 1st while, Singrauli ranked last (50th), in the
list of districts in Madhya Pradesh.
When background characteristics were compared to
study the trend within three sets of districts i.e
underdeveloped with developing and developing
with developed districts, it was observed that there
was significant (p<0.01) trend in the prevalence of
undernutrition
among three set of districts.
Similarly, significant (p<0.01) trend was observed in
proportion of children participating regularly in ICDS,
sanitary latrine use and use of iodized salt for
cooking among three set of districts. Significant
(p<0.05) trend was observed in proportion of
children belonging to SC/ST population and mothers
occupation as laborers among least developed and
developing districts (Table 3).
When comparison was made between the present
findings with IIPS 2006 ranking of districts, it was
observed that out of 12 districts classified as less
developed, 3 districts have gone in developing
districts, and remaining 9 as under developed
districts. Out of 26 developing districts in IIPS, 3
districts each moved towards less develop and
developed districts, while 20 districts remains in
same category, while 9 districts from developed
retains the same category and 3 districts moved
towards developing districts (Figure 1).

Discussion

207

INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

[Development of composite] | Venkaiah K et al

supervision was carried out in regular intervals by

the scientist from NIN to ensure quality of data
collected by the investigators

help. Last but not least, we are thankful to all the

participants involved in study.

Conclusion

1.

It was observed that Indore ranks 1st and Singrali

rank last in the set of districts. The study will help the
policy makers to divert the limited resources to the
least developed districts.

2.

References

Recommendation
3.

There is a need to intensify interventions in the

under-developed districts, as top priority districts (in
terms of undernutrition), and strengthening the
existing nutritional programmes in other districts as
the prevalenceof undernutrition is still high in other
districts.

Limitation of the study

4.

(If any)
5.

Data was used only on nutritional parameters and

per capita GDP of districts was not considered in the
present analysis.

Relevance of the study

6.

The study helps in ranking of districts based on some

developmental indicators in nutrition, so that more
attention should be given to less developed districts
and appropriate intervention strategies could be
adopted to prevent and control undernutrition in the
state.

7.

8.

Authors Contribution
All the authors were involved in design, concept and
planning of the study. Author 1 & 3 carried out
analyses, author 1& 2 was involved in drafting the
article, while others were involved in critically
reviewing the article.

9.

10.

Acknowledgement
Authors are thankful to the Principal Secretary,
Deputy & Joint Secretaries, Director and Deputy
Director, Women and Child Development & Social
Justice Department, Ministry of Health & Family
Welfare, Government of Madhya Pradesh for
providing an opportunity to carry out this study. We
are also thankful to Districts Project Officers, Child
Development Project
Officers,
Supervisors,
Anganwadi Workers (AWWs), and ASHA worker
(Health functionaries) in the execution of the survey.
Our sincere thanks to the entire field staff for their
sincere efforts in the data collection. We also thank
Mr. Raghunath Babu, Technical Assistant, Mrs. G.
Madhavi, Technician, and others for their technical

11.

12.

13.

14.

208

Foa R, Tanner JC. Methodology of the indices of social

development,
2009.
http://www.indsocdev.org/resources/Methodology%20of
%20the%20Social%20Development
%20Indices_%20jan11.pdf
Mazziotta M, Pareto A. Methods for constructing
composite indices: one for all or all for one? Rivista Italiana
di Economia Demografia e Statistica 2013; LXVII :67-80
United Nations Development Programme (UNDP), Human
development
Reports.
http://hdr.undp.org/en/content/human-developmentindex-hdi
United Nations Development Programme (UNDP), Human
Development Report 2007/2008. Fighting climate change:
Human solidarity in a divided world. Palgrave Macmillan,
Houndmills, Basingstoke, Hampshire RG21 6XS and 175
Fifth Avenue, New York, NY 10010
United Nations Development Programme (UNDP), Human
Development Report 2010. The Real Wealth of Nations:
Pathways to Human Development Palgrave Macmillan,
Houndmills, Basingstoke, Hampshire RG21 6XS and 175
Fifth Avenue, New York, NY 10010
73rd and 74th Constitution Amendment Act 1992. Taken
from
http://gsera.com/73rd-and-74th-constitutionamendment-acts-1992.html
Muthumurugan P, Muthaiyan P, Elumalai B. Composite
index analysis of inter-regional variations in agricultural
development of Tamil Nadu. Inter J Social Sci &
Interdisciplinary Res 2012; 1:58-62.
Narain P, Sharma SD, Rai SC, Bhatia VK. Inter-District
Variation of Socio-economic Development in Andhra
Pradesh. J. Ind. Soc. Agri Stat 2009; 63(1): 35-42.
Ram F, Shekhar C. Ranking and mapping of districts based
on socioeconomic and demographic indicators. Ministry of
Health and Family Welfare, Government of India.
International Institute for Population Sciences (IIPS),
Mumbai-400088. 2006
National Institute of Nutrition (NIN), Assessment of
nutritional status of under five year rural children in the
districts of Madhya Pradesh State and functionaries of ICDS,
2011.
Census
of
India
2011.
Taken
from
http://censusindia.gov.in/2011-provresults/prov_data_products_MP.html
Annual health survey; Madhya Pradesh. Office of the
Registrar General & Census Commissioner, India, Ministry
of Home Affairs, Government of India, 2/A, Mansingh Road,
New Delhi-110 011, 2011-12.
Iyengar, N.S, Sudarshan P, A Method of Classifying Regions
from Multivariate Data, Economic and Political Weekly,
Special Article 1982: 2048-52.
Cholakkal I. Inter-District Variations in Education and Health
Care in Kerala: A Review in the Context of Inclusive growth.
IOSR Journal of Economics and Finance (IOSR-JEF) 2013; 1:
28-34. Ministry of Health and Family Welfare. Reproductive
and Child Health Programme: Schemes for Implementation.
New Delhi, 1997.

INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

15. Narain P, Sharma SD, Rai SC, Bhatia VK. Dimensions of

regional disparities in socioeconomic development in
Madhya Pradesh. J. Ind. Soc. Agril Stat 2002; 55: 88-107.

[Development of composite] | Venkaiah K et al

16. District
Profile
Indore,
Taken
http://indore.nic.in/Profile_INDORE2012.pdf
17. District
Profile
of
Singrauli,
Taken
http://singrauli.nic.in/teacher/profile.pdf.

Tables
TABLE 1 DESCRIPTIVE STATISTI CS OF SELECTED INDICATORS
S. No
Indicator (%)
1
Birth order three and above
2
Maternal age at the time of marriage (<18 years)
3
Fully immunized
4
Female literacy rate
5
Safe drinking water
6
Toilet facility
7
Electricity
8
Women received >=3 ANC visits
9
Women received 2 TT injections
10
% of Population 0-5 years
11
Under 5 Mortality / 1000
12
Prev. of Underweight

Mean (%)
35.5
0.98
84.5
48.43
81.04
12.12
74.69
36.91
86.33
14.8
90.8
51.8

TABLE 2 RANKING OF DISTRICTS ACCORDING TO COMPOSI TE INDEX VALUE

District
CI
Indore
0.7881
Balaghat
0.7841
Narasimhapur
0.7817
Jabalpur
0.7785
Betul
0.751
Hoshangabad
0.7468
Bhopal
0.7442
Harda
0.7263
Neemuch
0.712
Ujjain
0.7104
Raisen
0.6985
Seoni
0.698
Dewas
0.6878
Chindwara
0.6795
Anuppur
0.6623
Mandsaur
0.658
Ratlam
0.6575
Sehore
0.6558
Burhanpur
0.6498
Bhind
0.6359
Shajapur
0.627
Khandwa
0.6179
Gwalior
0.6163
Morena
0.6099
Vidisha
0.6091
Sagar
0.6088
Katni
0.6085
Khargone
0.5889
Dhar
0.5693
Dindori
0.5669

Min (%)
21.0
0.0
32.1
13.0
41.4
0.8
18.0
7.9
55.3
11.7
51
34.7
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

TABLE 2 CONTINUE RANKING OF DISTRICTS ACCORDING TO COMPOSITE INDEX VALUE

District
CI
Rank
209

Max (%)
51.0
4.1
100.0
78.8
99.2
41.2
97.7
100.0
100.0
20.3
140
67.1

from
from

INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 27 / ISSUE NO 02 / APR JUN 2015

Datia
Chhatarpur
Mandla
Rajgarh
Sheopur
Guna
Shivpuri
Damoh
Ashokngar
Rewa
Jhabua
Sidhi
Panna
Tikamgarh
Shahdol
Alirajpur
Sathna
Barwani
Umaria
Singrauli

0.5564
0.5509
0.5503
0.5454
0.5396
0.5239
0.5209
0.5193
0.507
0.4892
0.4868
0.4741
0.4673
0.4666
0.4524
0.4107
0.4014
0.3927
0.3716
0.321

[Development of composite] | Venkaiah K et al

31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

TABLE 3 DIFFERENCE IN NUTRIT IONAL STATUS AND BAC KGROUND CHARACTERIST ICS OF HHS IN THREE
DIFFERENT CATEGORIES OF DEVELO PMENT
Parameter
Under Developed
Developing
Developed
Stunting
54.7a
49.8b
40.8c
Wasting
28.2a
25.9 b
23.4c
% of SC/ST Population
58.1a
43.9 b
43.3
Occupation of mother as labourer
35.5a
26.4 b
26.3
Regular participation in ICDS
33.8a
50.1b
58.6c
Sanitary latrine presence and in use
5.5a
10.3 b
22.3 c
Using Iodized salt (15 ppm)
34.2a
41.2 b
73.2c

210