Risk factors for chronic undernutrition among children in India: Estimating relative importance, population
Daniel J Corsi1, Iván Mejía-Guevara2, S V Subramanian3
1Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Insights
Child undernutrition in India remains high. Key factors include maternal stature, education, household wealth, and dietary diversity, which together explain over 67% of stunting and underweight cases. Addressing these social and nutritional determinants is crucial for child growth.
Area of Science:
- Public Health
- Pediatrics
- Nutrition Science
Background:
- Child undernutrition, particularly stunting and underweight, is a major public health challenge in India, affecting nearly 40% of the world's affected children.
- Despite numerous interventions, the relative importance of various risk factors within a multifactorial framework remains unclear.
Purpose of the Study:
- To assess the simultaneous contribution of 15 known risk factors to child chronic undernutrition in India.
- To identify the most significant predictors of stunting and underweight in Indian children aged 6-59 months.
Main Methods:
- Utilized data from the 3rd Indian National Family Health Survey (NFHS-3) conducted in 2005-2006.
- Employed logistic regression to calculate age/sex-adjusted and multivariable adjusted odds ratios, Population Attributable Risks (PAR), and Population Attributable Fractions (PAF) for 15 risk factors.
- Analyzed data from 26,842 children for stunting and 27,483 children for underweight.
Main Results:
- Short maternal stature, lack of maternal education, lowest household wealth quintile, poor dietary diversity, and maternal underweight were the five most significant predictors of childhood stunting and underweight.
- These five factors accounted for a combined Population Attributable Risk of 67.2% for stunting and 69.7% for underweight.
- The remaining ten factors contributed a combined PAR of 11.7% for stunting and 15.1% for underweight.
Conclusions:
- Interventions must address broader social determinants like maternal health, education, and household economic status, alongside nutritional programs promoting dietary adequacy and diversity.
- A multifactorial approach focusing on these key predictors is essential for improving child growth and development trajectories in India.
- Targeting maternal short stature, education, household wealth, and dietary diversity offers the greatest potential for reducing child undernutrition in India.
Abstract:
Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005-2006. The study population consisted of children aged 6-59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3-70.7) and 69.7% (95% CI: 66.3-72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0-17.4) and 15.1% (95% CI: 8.9-21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific programs to promote dietary adequacy and diversity are required to ensure a long term trajectory of optimal child growth and development in India.
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