Stunting among Preschool Children in India: Temporal Analysis of Age-Specific Wealth Inequalities

Unveiling subgroup trends of stunting and wasting in Indian children: a serial cross-sectional analysis from National Family Health Surveys 3-5

BACKGROUND

India grapples with a dual burden of child wasting and stunting and stark socio-economic and regional disparities.

OBJECTIVES

We aimed to better understand trends in the prevalence of childhood stunting and wasting, with an emphasis on its disproportionate effects on marginalized populations, by analyzing National Family Health Surveys (NFHS) data from 2005 to 2020.

METHODS

We analyzed trends in the distribution of childhood height-for-age Z (HAZ) and weight-for-height Z (WHZ) scores using anthropometric data from 3 surveys, NFHS 3, 4, and 5. We examined disparities by wealth, caste, tribe, area of residence (rural compared with urban), and sex and mapped trends against India's evolving policy landscape. We also conducted a regression analysis of HAZ and WHZ risk factors.

RESULTS

In the context of an evolving nutrition-centered policy landscape, disparities by level of wealth in both HAZ and WHZ decreased in the study period (HAZ: estimate = 0.27, confidence interval [CI]: 0.16, 0.38; and WHZ: estimate = 0.11, CI: 0.01, 0.22), though there were no improvements in disparities for marginalized castes (HAZ: estimate = 0.07, CI: 0.00, 0.13; and WHZ: estimate = 0.02, CI: -0.04, 0.08). Though they have narrowed, disparities by wealth, caste, tribe, and area of residence persist, with undernutrition at birth, as measured by HAZ and WHZ, a particularly acute problem.

CONCLUSIONS

Although there have been significant reductions in disparities by wealth in mean HAZ and WHZ scores in India, persistent disparities by caste, tribe, and area of residence necessitate reinvestments in targeted interventions. Further, despite this narrowing of disparities and overall progress against stunting, anthropometric scores in early childhood continue to be low in India, especially with regard to wasting, indicating the importance of not only maternal nutrition and care for newborns but more comprehensive efforts to address poverty and other factors that contribute to undernutrition, with a focus on vulnerable populations.

Stunting disparities and its associated factors among preschool children of employed and unemployed mothers in Gondar City: a comparative community-based cross-sectional study

Introduction

A stunted child refers to a child who is too short for his/her age, which is the most common cause of morbidity and mortality in children under five in developing countries. Stunting in preschool children is caused by a multitude of socioeconomic and child-related factors, including the employment status of women. This study aimed to compare the prevalence and factors associated with stunting of preschool children among employed and unemployed mothers in Gondar city, Northwest Ethiopia, in 2021.

Methods

From 30 February to 30 March 2021, a community-based comparative cross-sectional study was conducted among 770 preschool children of employed and unemployed mothers in Gondar city. A structured questionnaire-based interview with anthropometric measurements was used to collect data. A multi-stage sampling technique was used. Data were entered into EPI Info version 7.22 and transferred to Stata version 14 for further analysis. To identify factors associated with stunting, a binary logistic regression analysis was used. The presence of an association was declared based on a p-value of <0.05 and confidence intervals.

Results

A total of 770 preschool children participated in the study. The overall prevalence of stunting among preschool children was 39.7% (95% CI: 36.3-43.2). The prevalence was higher among preschool children of employed mothers (42.6%) (95% CI: 37.6-47.5) than among unemployed mothers (36.7%) (95% CI: 32.0-41.7). Maternal age [AOR = 2.8, 95% CI: 1.26-6.34] and wealth status [AOR = 0.32, 95% CI: 0.18-0.57] were significantly associated with stunting among unemployed mothers, while family size [AOR = 7.19, 95% CI: 2.95-17.5], number of children under the age of five [AOR = 1.92, 95% CI: 1.12-3.29], and having a home servant [AOR = 0.126, 95% CI: 0.06-0.26] were associated with stunting of preschool children among employed mothers.

Conclusion

Stunting is more common in preschool children of employed mothers than in those of unemployed mothers. As a result, interventions such as raising awareness among employed mothers to devote time and care to their children, as well as concerned bodies assisting women with preschool or under-five children, is required. The nutrition intervention should focus on encouraging dietary diversity to combat the existing nutrition-associated stunting in children. Similarly, further research on the difference between employed and unemployed mothers' child stunting status as well as an investigation of extra variables such as the number of hours worked by an employed mother is also recommended to upcoming researchers.

Low Birth Weight, the Differentiating Risk Factor for Stunting among Preschool Children in India

Background: The prevalence of low birth weight (LBW) is a major public health issue in India; however, the optimal growth pattern for such infants is not clear. The purpose of this study is to understand the causal association between LBW and stunting of preschool children in India. Methods: The National Family Health Survey-4 is a large cross-sectional survey based on a nationally representative sample of 699,686 women in the age group of 15−49 years and was conducted during 2015−2016 in India. The study used the children’s file with a sample of 259,002 of 0−59 months for investigation. Results: The data revealed that 38.7% of the children in India were stunted. The bivariate analysis revealed that, of the women who did not attend any antenatal care (ANC) meetings, 46.8% had stunted children compared to the women who attended more than three ANC meetings, which 30.7% had stunted children. The low birth weight children experienced a much higher chance of stunting compared to children with a normal birth weight (44.3% vs. 33.8%). The multivariable odds ratios of logistic regression, after adjusting for the confounding characteristics, showed that pregnant women attending more than three ANC meetings compared to not attending any ANC meetings experienced a 19% lower adjusted odds ratio (AOR) of having stunted children (AOR = 0.81; CI 0.78, 0.85; p < 0.001). Another important variable, such as women with underweight body mass index (BMI) compared with normal BMI, had 6% higher odds of having stunted children (AOR = 1.06; CI 1.03, 1.10; p < 0.001). Similarly, women who belong to the Scheduled Caste compared to the General Caste had 36% higher odds of having stunted children (AOR = 1.36; CI 1.30, 1.42; p < 0.001); and children aged 13−23 months compared to children up to one-year-old or younger had 141% higher odds of being stunted (AOR = 2.41; CI 2.32, 2.51; p < 0.001). The conspicuous finding is that LBW babies, after adjusting for other important confounding factors, such as BMI and ANC, experienced 19% higher odds of stunted children (AOR = 1.19; CI 1.14, 1.24; p < 0.001) compared to normal birth weight babies. Conclusions: The results revealed LBW is associated with stunting of preschool children in India.

Can Anganwadi services strengthening improve the association between maternal and child dietary diversity? Evidence from Project Spotlight implemented in tribal dominated Gadchiroli and Chandrapur districts of Maharashtra, India

Dietary intake is a fundamental determinant of maternal and child nutrition. This paper presents evidence on whether maternal and child dietary diversity can be improved with systemic improvements focused on strengthening training, capacity building, and behavior change communication among frontline workers to encourage improved nutritional practices among mothers and children in the intervention area. The evidence is derived from Project Spotlight intervention that was jointly implemented by Department of Women and Child Development, Government of Maharashtra and Tata Trusts in tribal dominated Gadchiroli and Chandrapur districts in Maharashtra. Based on a pre-post comparison of baseline (2019) and endline (2021) household survey data it is confirmed that there is a significant association between maternal and child dietary diversity in the study area. Notably, dietary diversity in mother-child dyads is marked with a higher consumption of fruits and vegetables as well as eggs and flesh foods. Econometric analysis further reveals that the association between maternal and child dietary diversity has improved after the systems strengthening interventions. The paper concludes that local interventions such as Project Spotlight for strengthening counselling services and coverage by frontline workers and enhancing knowledge and awareness on maternal and child dietary diversity among communities are important for improving maternal and child nutrition.