Geographic disparities in minimum dietary diversity among Indian children aged 6-23 months

Dietary diversity is a critical determinant of children's nutritional well-being and micronutrient intake, particularly during the complementary feeding period (6-23 months). This study examines geographic disparities in minimum dietary diversity (MDD) among Indian children aged 6-23 months, emphasizing its role in addressing malnutrition. Despite India's high burden of child undernutrition, less than one-third of children meet the WHO's MDD standards. The study aligns with Sustainable Development Goal 2 (SDG 2), zero hunger, aiming to identify regional inequalities and inform targeted interventions.

Using data from the National Family Health Survey-5 (NFHS-5, 2019-2021), this study analyzed a final sample of 63,247 children aged 6-23 months. Predictor variables included individual, maternal, and household-level factors, while MDD was defined as the consumption of foods from at least five out of eight food groups. Spatial analysis techniques, including choropleth mapping, Getis-Ord Gi* hotspot analysis, Ordinary Kriging interpolation, and Geographically Weighted Regression (GWR), were employed to explore geographic variations and their determinants.

The prevalence of inadequate MDD was 77.06%, with significant geographic disparities. Districts in the southern and north-eastern states exhibited better dietary practices, whereas most districts in central and northern regions, including Bihar, Uttar Pradesh, Madhya Pradesh and Chhattisgarh showed alarmingly high inadequacy rates (80.10-96.00%). GWR analysis revealed spatially varying relationships between predictors and inadequate MDD across Indian districts. For instance, Southern districts, especially in Tamil Nadu, Kerala, Karnataka, and parts of Andhra Pradesh, showed strong negative coefficients (-0.427 to - 0.250), indicating that better toilet facilities are linked to lower levels of inadequate MDD. Similarly, most districts in states like Uttar Pradesh, Bihar, Madhya Pradesh, Maharashtra, Odisha, Chhattisgarh, West Bengal, Andhra Pradesh, Kerala and Telangana show negative coefficients (-0.253 to 0.000), indicating that greater maternal exposure to mass media is associated with lower inadequate MDD. Furthermore, districts in southern, western, and eastern India, including Tamil Nadu, Karnataka, Maharashtra, Andhra Pradesh, Telangana, Odisha, West Bengal, and the northeastern states, show strong positive associations (coefficients 0.401 to 0.800), indicating that higher prevalence of underweight mothers is linked to poorer child dietary diversity.

This study highlights critical geographic disparities in inadequate MDD among children aged 6-23, emphasizing the need for region-specific interventions. Central and northern regions require urgent attention due to the high clustering of inadequate dietary diversity, while southern and northeastern states demonstrate favourable conditions. Integrated approaches addressing maternal nutrition, sanitation facilities, maternal exposure to mass media, and maternal age at first birth are essential for reducing the level of inadequate dietary diversity.