Unveiling Sub-group Trends of Stunting and Wasting in Indian Children: A Serial Cross-sectional Analysis from National Family Health Surveys 3-5.

Abstract

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

Objective: 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 three surveys, NFHS 3, 4, and 5. We examined disparities by wealth, caste, tribe, area of residence (rural vs. 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, 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.