Identifying Geographical Heterogeneity in Associations between Under-Five Child Nutritional Status and Its Correlates Across Indian Districts

Abstract

India has substantially reduced the burden of under-five child malnutrition over the last two decades. Despite this, it is still gigantic and differs remarkably across districts, while the demographic and socio-economic groups are most affected by it. This paper aimed to decrypt the place-specific spatial dependence and heterogeneity in associations between district-level nutritional status (stunting, wasting and underweight) and its considered correlates using a geocoded database for all 640 Indian districts from the latest fourth wave of the National Family Health Survey, 2015–16. Univariate Moran’s I and LISA statistics were used to confirm the spatial clustering and dependence in under-five nutritional status. The Ordinary Least Square (OLS), Geographically Weighted Regression (GWR), Spatial (lag/error) models were employed to examine the effects of correlates on the district-level nutritional status. The mean (Moran’s I) district-level stunting, wasting and underweight were 38% (0.634), 21% (0.488) and 36% (0.721), respectively. The GWR results disclosed that the spatial heterogeneity in relationships between district-level nutritional status and its driving forces were strongly location-based, altering their direction, magnitude and strength across districts. Overall, the localized model performed better, and best fit the data than the OLS and spatial (lag/error) models. This nationwide study confirmed that the spatial dependencies and heterogeneities in the district-level nutritional status indicators were strongly explained by a multitude of factors and thus can help policymakers in formulating effective nutrition-specific programmatic interventions to speed up the coverage of under-five malnutrition status in most priority districts and geographical hot spots across India.