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Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions

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  • Corsi, Daniel J.
  • Mejía-Guevara, Iván
  • Subramanian, S.V.

Abstract

Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005–2006. The study population consisted of children aged 6–59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3–70.7) and 69.7% (95% CI: 66.3–72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0–17.4) and 15.1% (95% CI: 8.9–21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific programs to promote dietary adequacy and diversity are required to ensure a long term trajectory of optimal child growth and development in India.

Suggested Citation

  • Corsi, Daniel J. & Mejía-Guevara, Iván & Subramanian, S.V., 2016. "Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions," Social Science & Medicine, Elsevier, vol. 157(C), pages 165-185.
    • Handle: RePEc:eee:socmed:v:157:y:2016:i:c:p:165-185
    DOI: 10.1016/j.socscimed.2015.11.014
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    1. Sunil Rajpal & Rockli Kim & William Joe & S.V. Subramanian, 2020. "Stunting among Preschool Children in India: Temporal Analysis of Age-Specific Wealth Inequalities," IJERPH, MDPI, vol. 17(13), pages 1-16, June.
    2. Agarwal, Sandip K. & Mishra, Shubham, 2024. "Health impact evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey," Economics & Human Biology, Elsevier, vol. 54(C).
    3. Kim, Rockli & Rajpal, Sunil & Joe, William & Corsi, Daniel J. & Sankar, Rajan & Kumar, Alok & Subramanian, S.V., 2019. "Assessing associational strength of 23 correlates of child anthropometric failure: An econometric analysis of the 2015-2016 National Family Health Survey, India," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    4. Humphries, Debbie L. & Dearden, Kirk A. & Crookston, Benjamin T. & Woldehanna, Tassew & Penny, Mary E. & Behrman, Jere R., 2017. "Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam," Economics & Human Biology, Elsevier, vol. 26(C), pages 30-41.
    5. Purushotham, Anjali & Mittal, Nitya & Ashwini, B.C. & Umesh, K.B. & von Cramon-Taubadel, Stephan & Vollmer, Sebastian, 2022. "A quantile regression analysis of dietary diversity and anthropometric outcomes among children and women in the rural–urban interface of Bangalore, India," Food Policy, Elsevier, vol. 107(C).
    6. Suman Chakrabarti & Samuel P. Scott & Harold Alderman & Purnima Menon & Daniel O. Gilligan, 2021. "Intergenerational nutrition benefits of India’s national school feeding program," Nature Communications, Nature, vol. 12(1), pages 1-10, December.
    7. Kate Rich & Liezel Engelbrecht & Gabrielle Wills & Edzani Mphaphuli, 2024. "Mitigating the impact of intergenerational risk factors on stunting: Insights from the Grow Great Community Stunting Survey," Working Papers 02/2024, Stellenbosch University, Department of Economics.
    8. Astrid M. Knoblauch & Mark J. Divall & Milka Owuor & Colleen Archer & Kennedy Nduna & Harrison Ng’uni & Gertrude Musunka & Anna Pascall & Jürg Utzinger & Mirko S. Winkler, 2017. "Monitoring of Selected Health Indicators in Children Living in a Copper Mine Development Area in Northwestern Zambia," IJERPH, MDPI, vol. 14(3), pages 1-17, March.

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