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Risk factors and socioeconomic inequalities in undernutrition among children 0-59 months of age in India

Thirupathi Reddy Mokalla, Vishnu Vardhana Rao Mendu


In the majority of low- and middle-income counties, child health-care dissimilarities are further aggravated by nutritional status (i.e., stunting, underweight, and wasting). In India, child malnutrition is the most important contributor to disease burden. The present study uses data from the 4th round of the National Family Health Survey (NFHS-4), conducted in 2015-2016. We considered anthropometric indicators of unit-level data of 2, 48, and 174 children aged 0-59 months. This study examines the socio-economic inequality in nutritional status and their determinants among under-5 year children. The factors considered in the analysis were categorized as child age in months, mother’s educational status, mother’s nutritional-status, type of caste, wealth index, birth order, and size of a child at birth. In this study, multivariate logistic regression and concentration index (CI) have been employed to explore the effect of various factors on the child’s nutritional status. The binary logistic analysis has demonstrated a significant association between child nutritional status and mother’s education, mother’s nutritional status, type of caste, wealth index, birth order, and size of a child at birth. The results show that the CI for stunting, underweight, and wasting were −0.14, −0.16, and −0.08. Therefore, these factors were significantly high in poorer households. Our study suggests that the nutrition-specific programs to encourage nutritional adequacy, diversity, reduces the nutritional burden, and growth of child’s in India.



India; Stunting; Wasting; Underweight; Logistic regression; Concentration index

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Agrawal T, Farrell TJ, Wethington E and Devine CM. (2019). Change and Continuity in Low-Income Working Mothers’ Food Practices for Young Children in Response to Life Events. Maternal and Child Health Journal, 23(9):1206-1212.

Akombi BJ, Agho KE, Merom D, Hall JJ and Renzaho AM. (2017). Multilevel Analysis of Factors Associated with Wasting and Underweight among Children under-five Years in Nigeria. Nutrients, 9(1):E44.

Alom J, Amirul M and Quddus IM. (2009). Socioeconomic Factors Influencing Nutritional Status of Under-Five Children of Agrarian Families in Bangladesh: A Multilevel Analysis. Bangladesh Journal of Agricultural Economics, 1(2):63-74. Available from: Vol-XXXII.pdf. [Last accessed on 2018 Mar 14].

Banerjee S, Alok S, Lakhtakia S and Mahapatra MS. (2019). Determinants of Women Empowerment and Effect on Children’s Overall Health Development. IASSI Quarterly, 38(2):276-291.

Bewick V, Cheek L and Ball J. (2005). Statistics Review 14: Logistic Regression. Critical care (London, England), 9(1):112-118.

Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M and Rivera J. (2008). Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences. The Lancet, 371(9608):243-260.

Boah M, Azupogo F, Amporfro DA and Abada LA. (2019). The Epidemiology of Undernutrition and its Determinants in Children under Five Years in Ghana. PLoS One, 14(7):e0219665.

Corsi DJ, Mejía-Guevara I and Subramanian SV. (2015). Risk Factors for Child Chronic Undernutrition in India: Estimating Relative Importance, Population Attributable Risk and Fractions. Social Science and Medicine, 157:165-185.

Das AC. (2015). Childhood Mortality and Child Nutritional Status of Bangladesh: A Review on Demographic and Health Survey. Journal of Current and Advance Medical Research, 2(2):42.

Dessie ZB, Fentie M, Abebe Z, Ayele TA and Muchie KF. (2019). Maternal Characteristics and Nutritional Status among 6-59 Months of Children in Ethiopia: Further Analysis of Demographic and Health Survey. BMC Pediatrics, 19(1):83.

Giashuddin SM, Rahman A, Rahman F, Mashreky SR, Chowdhury SM, Linnan M and Shafinaz S. (2009). Socio-economic Inequality in Child Injury in Bangladesh Implication for Developing Countries. International Journal for Equity in Health, 8:7.

Hetherington MM and McNally J. (2020). Reading Appetite Cues in Infancy: A Role for Nutrition Education. In: Nutrition Education: Strategies for Improving Nutrition and Healthy Eating in Individuals and Communities. Vol. 92. Berlin, Germany: Karger Publishers. p41-51.

Hosangadi D, Smith PG, Kaslow DC and Giersing BK. (2019). WHO Consultation on ETEC and Shigella burden of Disease, Geneva, 6-7th April 2017: Meeting Report. Vaccine, 37(50):7381-7390.

IIIPS. (2017). National Family Health Survey (NFHS-4) 2015-16 India. Mumbai, Maharashtra: International Institute for Population Sciences (IIPS) and ICF.

Islam MR, Rahman MS, Rahman MM, Nomura S, De Silva A, Lanerolle P and Rahman MM. (2019) Reducing Childhood Malnutrition in Bangladesh: The Importance of Addressing Socio-Economic Inequalities. Public Health Nutrition, 23(1):72-82.

Kang Y and Kim J. (2019). Risk Factors for Undernutrition among Children 0-59 Months of Age in Myanmar. Maternal and Child Nutrition, 15(4):e12821.

Khan S, Zaheer S and Safdar NF. (2019). Determinants of Stunting, Underweight and Wasting among Children < 5 Years of Age: Evidence from 2012-2013 Pakistan Demographic and Health Survey. BMC Public Health, 19(1):358.

Kumar A, Kumari D and Singh A. (2015). Increasing Socio-economic Inequality in Childhood Undernutrition in Urban India: Trends between 1992-93, 1998-99 and 2005-06. Health Policy and Planning, 30(8):1003-1016.

Markos Z. (2014). Predicting Under Nutrition Status of Under-Five Children Using Data Mining Techniques: The Case of 2011 Ethiopian Demographic and Health Survey. Journal of Health and Medical Informatics, 5(2):2-11.

Messelu Y and Trueha K. (2016). Determining Risk Factors of Malnutrition among under Five Children in Sheka Zone, South West Ethiopia Using Ordinal Logistic Regression Analysis. Public Health Research, 6(6):161-167.

Mishra S, Pandey CM, Chaubey YP and Singh U. (2015). Determinants of Child Malnutrition in Empowered Action Group (EAG) States of India. Statistics and Applications, 13(13):2454-7395.

Multicentre WHO, Reference G and Group S. (2006) WHO Child Growth Standards Based on Length/height, Weight and Age. Acta Paediatrica, 450:76-85.

O’Donnell O, van Doorslaer E, Wagstaff A and Lindelow M. (2008). Analyzing Health Equity Using Household Survey Data. Washington, DC: Health Equity Using.

Prado EL and Dewey KG. (2014). Nutrition and Brain Development in Early Life. Nutrition Reviews, 72(4):267-284. Available from: [Last accesses on 2020 Apr 29].

Rahman M and Sultana P. (2019). Distribution and Risk Factors of Child Malnutrition in Bangladesh, based on Bangladesh Demographic and Health Survey-2014 Data. Journal of Biometrics and Biostatistics, 10(1):425.

Rahman M. (2016). Association between 004Frder of Birth and Chronic Malnutrition of Children: A Study of Nationally Representative Bangladeshi Sample. Cadernos de Saúde Pública, 32(2):e00011215.

Singh S, Srivastava S, and Upadhyay AK. (2019). Socio-Economic Inequality in Malnutrition among Children in India: An Analysis of 640 Districts from National Family Health Survey (2015-16). International Journal for Equity in Health, 18(1):203.

Talukder A. (2017). Factors Associated with Malnutrition among Under-Five Children: Illustration using Bangladesh Demographic and Health Survey, 2014 Data. Children, 4(10):88.

UNICEF. (2011). The Situation of Children in India A Profile. UNICEF India. Available from: [Last accessed on 2018 Feb 23].

UNICEF. (2019). Reducing Stunting and Wasting in Children and Women. UNICEF India. Available from: india/reports/reducing-stunting-and-wasting-children-and-women. [Last accessed on 2020 Apr 28].

Uthman O. (2012). A multilevel Analysis of the Effect of Household Wealth Inequality on under-five Child under-nutrition: Evidence from the 2003 Nigeria Demographic and Health Survey. The Internet Journal of Nutrition and Wellness, 6(2):1-9.

Vir, S. (2013). Community Based Maternal and Child Health Nutrition Project, Uttar Pradesh: An Innovative Strategy Focusing on “at Risk” Families. Indian Journal of Community Medicine, 38(4):234-239.

Wagstaff A, Paci P and van Doorslaer E. (1991). On the Measurement of Inequalities in Health. Social Science and Medicine, 33(5):545-557.

World Health Organization. (2010). Interpretation Guide Nutrition Landscape Information System (NLIS). Geneva: World Health Organization.

Zere E, Tumusiime P, Walker O, Kirigia J, Mwikisa C and Mbeeli T. (2010). Inequities in Utilization of Maternal Health Interventions in Namibia: Implications for Progress Towards MDG 5 Targets. International Journal for Equity in Health, 9:16.

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