Regional Differences of Child Undernutrition in India: The Reflection of Composite Index of Anthropometric Failure (CIAF) from CNNS-2016-18 Data.

ABSTRACT

Background: The Composite Index of Anthropometric Failure (CIAF) has its multifaceted application in understanding child undernutrition. The nationwide data of Community National Nutrition Survey (CNNS) 2016-18 in India has unfolded this opportunity to re-examine the use of CIAF and its determinants. One recent study showed significant differences in child undernutrition between rich and poor wealth index households using this CNNS -16-18 data. But, the study did not consider regional as well as state-wise CIAF variation. However, it is a fact that regional understanding of child undernutrition is equally vital for national and regional health and nutritional planning, specifically in India. Therefore, the present study aims to understand the geographical region and state-wise distribution of CIAF and determine some selected determinants of CIAF. Methods: The study used secondary data set from the Community National Nutrition Survey (CNNS), India undertaken in 2016-18. The study sample comprised of 32941 children aged 0-59 months. The multivariate logistic regression models were used to explore the determinants of CIAF. Results: The results revealed that nearly half of the under-five children suffered from undernutrition (CIAF-46.71%). The final adjusted multivariate regression models showed that the higher CIAF prevalence was mainly confined in the central region states like Madhya Pradesh (56.0%) and Uttar Pradesh (52.0%). Besides, the Jharkhand state in the eastern region showed the highest percentage of CIAF (57.0%). The prevalence of child undernutrition was more elevated in poor economic households and Muslim households. Children in the age group ?12 months, boys, who did not consume milk other than breast milk and lived in rural areas, had a higher prevalence of undernutrition. In the case of mother characteristics, mother's age at birth < 20 years, mother never attended school and mother did not watch television had a higher number of undernourished children. Despite several significant determinants associated with child undernutrition, the considerable impact of the region was consistent throughout the statistical models. Conclusion: Therefore, the vulnerable geographical regions and states in terms of child undernutrition should prioritise nutrition-sensitive interventions in India and consider the involvement of other key risk factors.