Immunization attributable burden of stunting among under-five children in India, 2005-2021

This study examined the stunting differences among Indian children of heterogenous socio-economic characteristics subject to their full immunization (FI) status. It also describes evidence of a declining stunting burden over time among fully immunized children across different socio-economic strata compared to their counter parts.

Children aged 12-59 months from NFHS, 2005-06 and 2015-16 and 2019-21 constitute the study sample. We applied bivariate cross-tabulation, NFHS round specific and a pooled binary logistic regression analysis to examine the unadjusted and adjusted odds for full immunization. We estimated the population attributable risk (PAR) associated with full immunization, applied a non-linear Blinder-Oaxaca decomposition analysis to examine the immunization-attributable gap in stunting, and finally applied the Fairlie decomposition analysis to assess the contribution of background characteristics to the fully immunized (FI)-not fully immunized (NFI) gap in stunting burden within the study population.

Nationally, stunting prevalence declined from 60% among those children not fully immunized during 2005-06 to 38% in 2019-21 among those who received all the doses of full immunization. Mother's education and household's economic wellbeing show a clear gradient in the stunting prevalence over time and by immunization status of the children. Decomposition analysis shows that immunization attributable burden of child stunting in India reduced substantially across different socio-economic strata.

Though several factors have contributed to the overall reduction of stunting, the FI-attributable burden of stunting has shown a reduction among the heterogeneous child population in India during 2005-2021. Thus, it is important to monitor the progress of immunization coverage among children from different socio-economic strata to further lower the stunting prevalence in India.