A success story of reduction in childhood stunting and underweight in India: analysis of pooled data from three rounds of Indian Demographic and Health Surveys (1998-2016)

Decoding India's Child Malnutrition Puzzle: A Multivariable Analysis Using a Composite Index

BACKGROUND

This study examines the levels and predictors of malnutrition in Indian children under 5 years of age.

METHODS

Composite Index of Anthropometric Failure was applied to data from the India National Family Health Survey 2019-2021. A multivariable logistic regression model was used to assess the predictors.

RESULTS

52.59% of children experienced anthropometric failure. Child predictors of lower malnutrition risk included female gender (adjusted odds ratio (AOR) = 0.881) and average or large size at birth (AOR = 0.729 and 0.715, respectively, compared to small size). Higher birth order increased malnutrition odds (2nd-4th: AOR = 1.211; 5th or higher: AOR = 1.449) compared to firstborn. Maternal predictors of lower malnutrition risk included age 20-34 years (AOR = 0.806), age 35-49 years (AOR = 0.714) compared to 15-19 years, normal BMI (AOR = 0.752), overweight and obese BMI (AOR = 0.504) compared to underweight, and secondary or higher education vs. no education (AOR = 0.865). Maternal predictors of higher malnutrition risk included severe anemia vs. no anemia (AOR = 1.232). Protective socioeconomic factors included middle (AOR = 0.903) and rich wealth index (AOR = 0.717) compared to poor, and toilet access (AOR = 0.803). Children's malnutrition risk also declined with paternal education (primary: AOR = 0.901; secondary or higher: AOR = 0.822) vs. no education. Conversely, malnutrition risk increased with Hindu (AOR = 1.258) or Islam religion (AOR = 1.369) vs. other religions.

CONCLUSIONS

Child malnutrition remains a critical issue in India, necessitating concerted efforts from both private and public sectors. A 'Health in All Policies' approach should guide public health leadership in influencing policies that impact children's nutritional status.

Exploring disparities in malnutrition among under-five children in Nigeria and potential solutions: a scoping review

Introduction

Triple burden of malnutrition in children remains a significant public health issue. This scoping review aims to assess the information on undernutrition, micronutrient deficiencies and the quality of complementary feeding in various regions in Nigeria.

Methods

A literature search was conducted using PubMed and Google Scholar databases from January 1, 2018 to January 31, 2023 to include studies focusing on 0 to 5 years old children in Nigeria, reporting data on nutritional status, nutrient deficiencies, and published in English.

Results

73 out of 1,545 articles were included. Stunting remained alarmingly high ranging from 7.2% (Osun, South West) to 61% (Kaduna, North Central), while wasting varied from 1% (Ibadan, South West) to 29% (FCT Abuja, Central) and underweight from 5.9% (Osun, South West) to 42.6% (Kano, North West) respectively. The overall prevalence of anemia and vitamin A deficiency ranged between 55.2 to 75.1 % and 5.3 to 67.6%, respectively. Low rates of achieving minimum dietary diversity and minimum meal frequency were reported across different states depicting the suboptimal quality of complementary feeding. The prevalence of overweight/obesity ranged from 1.5% (Rivers, South South) to 25.9% (Benue, North Central).

Conclusion

Multiple early childhood malnutrition issues exist with a wide disparity across states in Nigeria, particularly in the Northern region. Targeted nutrition interventions must be implemented to improve the situation.

Trends in the prevalence and social determinants of stunting in India, 2005-2021: findings from three rounds of the National Family Health Survey

Objectives

To assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021.

Methods

We leveraged data from three rounds of the National Family Health Survey (NFHS-3: 2005-2006, NFHS-4: 2015-2016, NFHS-5: 2019-2021) for 443 038 children under 5 years. Adjusted logistic regression models and a Kitigawa-Oaxaca-Blinder decomposition were deployed to examine how wealth, residence, belonging to a marginalised social group, maternal education and child sex contributed to changes in stunting prevalence.

Results

The decrease in stunting prevalence was notably slower between NFHS-4 and NFHS-5 (annual average rate of reduction (AARR): 1.33%) than between NFHS-3 and NFHS-4 (AARR: 2.20%). The protective effect of high wealth diminished from 2015 onwards but persisted for high maternal education. However, an intersection of higher household wealth and maternal education mitigated stunting to a greater extent than either factor in isolation. Residence only predicted stunting in 2005-2006 with an urban disadvantage (adjusted OR: 1.18; 95% CI: 1.07 to 1.29). Children from marginalised social groups displayed increased likelihoods of stunting, from 6-16% in 2005-2006 to 11-21% in 2015-2016 and 2020-2021. Being male was associated with 6% and 7% increased odds of stunting in 2015-2016 and 2019-2021, respectively. Increased household wealth (45%) and maternal education (14%) contributed to decreased stunting prevalence between 2005 and 2021.

Conclusions

Stunting prevalence in India has decreased across social groups. However, social disparities in stunting persist and are exacerbated by intersections of low household wealth, maternal education and being from a marginalised social group. Increased survival must be accompanied by needs-based interventions to support children and mitigate mutually reinforcing sources of inequality.

Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys

OBJECTIVE

To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4).

METHODS

National Family Health Survey data from 4 rounds (1992-2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under -2 z score were classified as malnourished by HAZ, WAZ and WHZ.

RESULTS

A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (-2.1 ± 1.8 to -1.5 ± 1.7) but relatively less improved weight for age (-1.8 ± 1.4 to -1.5 ± 1.2), the change in wasting status was either nil or meagre (-0.8 ± 1.4 to -0.9 ± 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4th NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05).

CONCLUSION

Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.