Dataset Information

Mapping of variations in child stunting, wasting and underweight within the states of India: the Global Burden of Disease Study 2000-2017.

ABSTRACT:

Background

To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states.

Methods

We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 × 5 km grid estimates, using all accessible data from various surveys with subnational geographical information. The states were categorised into three groups using their Socio-demographic Index (SDI) levels calculated as part of the Global Burden of Disease Study based on per capita income, mean education and fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using coefficient of variation (CV). We projected the prevalence of CGF indicators for the districts up to 2030 based on the trends from 2000 to 2017 to compare with the NNM 2022 targets for stunting and underweight, and the WHO/UNICEF 2030 targets for stunting and wasting. We assessed Pearson correlation coefficient between two major national surveys for district-level estimates of CGF indicators in the states.

Findings

The prevalence of stunting ranged 3.8-fold from 16.4% (95% UI 15.2-17.8) to 62.8% (95% UI 61.5-64.0) among the 723 districts of India in 2017, wasting ranged 5.4-fold from 5.5% (95% UI 5.1-6.1) to 30.0% (95% UI 28.2-31.8), and underweight ranged 4.6-fold from 11.0% (95% UI 10.5-11.9) to 51.0% (95% UI 49.9-52.1). 36.1% of the districts in India had stunting prevalence 40% or more, with 67.0% districts in the low SDI states group and only 1.1% districts in the high SDI states with this level of stunting. The prevalence of stunting declined significantly from 2010 to 2017 in 98.5% of the districts with a maximum decline of 41.2% (95% UI 40.3-42.5), wasting in 61.3% with a maximum decline of 44.0% (95% UI 42.3-46.7), and underweight in 95.0% with a maximum decline of 53.9% (95% UI 52.8-55.4). The CV varied 7.4-fold for stunting, 12.2-fold for wasting, and 8.6-fold for underweight between the states in 2017; the CV increased for stunting in 28 out of 31 states, for wasting in 16 states, and for underweight in 20 states from 2000 to 2017. In order to reach the NNM 2022 targets for stunting and underweight individually, 82.6% and 98.5% of the districts in India would need a rate of improvement higher than they had up to 2017, respectively. To achieve the WHO/UNICEF 2030 target for wasting, all districts in India would need a rate of improvement higher than they had up to 2017. The correlation between the two national surveys for district-level estimates was poor, with Pearson correlation coefficient of 0.7 only in Odisha and four small north-eastern states out of the 27 states covered by these surveys.

Interpretation

CGF indicators have improved in India, but there are substantial variations between the districts in their magnitude and rate of decline, and the inequality between districts has increased in a large proportion of the states. The poor correlation between the national surveys for CGF estimates highlights the need to standardise collection of anthropometric data in India. The district-level trends in this report provide a useful reference for targeting the efforts under NNM to reduce CGF across India and meet the Indian and global targets.

SUBMITTER: India State-Level Disease Burden Initiative CGF Collaborators

PROVIDER: S-EPMC7264980 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Importance:Evidence on the relative importance of various factors associated with child anthropometric failures (ie, stunting, underweight, and wasting) and their heterogeneity across countries can inform global and national health agendas. Objective:To assess the relative significance of factors associated with child anthropometric failures in 35 low- and middle-income countries (LMICs). Design, Setting, and Participants:This cross-sectional study of 299?353 children who were born singleton and aged 12 to 59 months with nonpregnant mothers and valid anthropometric measures assessed the strengths of associations of 26 factors with child stunting, underweight, and wasting, using Demographic and Health Surveys (2007-2018) from 35 LMICs. Data analysis was conducted from July 2019 to February 2020. Exposures:A total of 9 direct factors (ie, dietary diversity score; breastfeeding initiation; vitamin A supplements; use of iodized salt; infectious disease in past 2 weeks; oral rehydration therapy for children with diarrhea; care seeking for suspected pneumonia; full vaccination; and indoor pollution) and 17 indirect factors (household wealth; maternal and paternal education; maternal and paternal height and body mass index; maternal autonomy for health care, movement, and money; water source; sanitation facility; stool disposal; antenatal care; skilled birth attendant at delivery; family planning needs; and maternal marriage age) were assessed. Main Outcomes and Measures:Three anthropometric failure outcomes were constructed based on the 2006 World Health Organization child growth standards: stunting (height-for-age z score less than -2 standard deviations [SDs]), underweight (weight-for-age z score less than -2 SDs), and wasting (weight-for-height z score less than -2 SDs). Results:Among the 299?353 children aged 12 to 59 months included in the analysis, 38.8% (95% CI, 38.6%-38.9%) had stunting, 27.5% (95% CI, 27.3%-27.6%) had underweight, and 12.9% (95% CI, 12.8%-13.0%) had wasting. In the pooled sample, short maternal height was the strongest factor associated with child stunting (odds ratio [OR], 4.7; 95% CI, 4.5-5.0; P?<?.001), followed by lack of maternal education (OR, 1.9; 95% CI, 1.8-2.0; P?<?.001), poorest household wealth (OR, 1.7; 95% CI,1.6-1.8; P?<?.001), and low maternal body mass index (OR, 1.6; 95% CI, 1.6-1.7; P?<?.001). Short paternal height was also significantly associated with higher odds of stunting (OR, 1.9; 95% CI, 1.7-2.2; P?<?.001). Consistent results were found for underweight (eg, short maternal height: OR, 3.5; 95% CI, 3.3-3.7; P?<?.001; lack of maternal education: OR, 1.8; 95% CI, 1.7-2.0; P?<?.001) and wasting (eg, low maternal body mass index: OR, 2.3; 95% CI, 2.1-2,4; P?<?.001; poorest household wealth: OR, 1.2; 95% CI, 1.1-1.3; P?<?.001). Parental nutritional status and household socioeconomic conditions ranked the strongest (1st to 4th) for most countries, with a few exceptions (eg, lack of maternal education ranked 18th-20th in 8 countries for child wasting). Other factors were not associated with anthropometric failures in pooled analysis and had large country-level heterogeneity; for example, unsafe water was not associated with child underweight in the pooled analysis (OR, 0.97; 95% CI, 0.95-1.00; P?<?.001), and it ranked from 4th to 20th across countries. Conclusions and Relevance:In this study, socioeconomic conditions and parental nutritional status were the strongest factors associated with child anthropometric failures. Poverty reduction, women's education, and nutrition programs for households could be important strategies for reducing child undernutrition; however, country-specific contexts should be considered in national policy discussions.

Project description:BackgroundUndernutrition among preschool children in Northern region is the highest in Ghana. However, there is scarcity of data on the factors that determine undernutrition in these children. This study investigated the effect of maternal and child factors on undernutrition among preschool children in Northern Ghana.MethodsThis study was a community based analytical cross-sectional survey on a sample of 425 mother- child pairs drawn from 25 clusters. A semi- structured questionnaire was used to collect data on maternal and child socio-demographic characteristics, feeding practices and anthropometry. Anthropometric indices of Height-for-age Z-scores (HAZ), Weight-for-height Z-scores (WHZ) and Weight-for - age Z-scores (WAZ) were used to classify child stunting, wasting and underweight respectively. Bivariate and multivariate analyses were performed to determine associations between explanatory variables and undernutrition.ResultsThe prevalence of stunting, wasting and underweight were 28.2, 9.9 and 19.3% respectively. Multiple logistic regression analysis showed that, the odds of stunting was higher among male children [AOR = 1.99; 95% CI (1.26-3.13); p = 0.003], children of mothers less than 150 cm in height [AOR = 3.87; 95% CI (1.34-11.20); p = 0.01], mothers 155-159 cm tall [AOR = 2.21; 95% CI (1.34-3.66); p = 0.002], and older children aged 12-23 months [AOR 9.81; 95% CI (2.85-33.76); p < 0.001]. Wasting was significantly higher among male children [AOR = 2.40; 95% CI (1.189-4.844); p = 0.015], consumption of less than four food groups [AOR = 3.733; 95% CI (1.889-7.376); p < 0.001] and among children of underweight mothers [AOR = 3.897; 95% CI (1.404-10.820); p = 0.009]. Male children [AOR = 2.685; 95% CI (1.205-5.98); p = 0.016] and having low birth weight [AOR = 3.778; 95% CI (1.440-9.911); p < 0.001] were associated with higher odds of underweight in children.ConclusionMaternal height associated negatively with stunting but not wasting. Factors that affect low height -for-age z-score (HAZ) may not necessarily be the same as stunting. Infant and child feeding practices as measured by dietary diversity score associated positively with weight-for-height Z-scores than length-for-age Z-scores of young children. Surprisingly, consumption of some specific food groups including, animal source foods, legumes, staples and eggs were associated with lower HAZ but with increased likelihood of higher WHZ among children 6-59 months.

Project description:In 2016, undernutrition, as manifested in childhood stunting, wasting, and underweight were estimated to cause over 1.0 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life years globally. The objective of this study is to estimate the prevalence of undernutrition in low- and middle-income countries (LMICs) using the 2006-2018 cross-sectional nationally representative demographic and health surveys (DHS) data and to explore the sources of regional variations. Anthropometric measurements of children 0-59 months of age from DHS in 62 LMICs worldwide were used. Complete information was available for height-for-age (n = 624,734), weight-for-height (n = 625,230) and weight-for-age (n = 626,130). Random-effects models were fit to estimate the pooled prevalence of stunting, wasting, and underweight. Sources of heterogeneity in the prevalence estimates were explored through subgroup meta-analyses and meta-regression using generalized linear mixed-effects models. Human development index (a country-specific composite index based on life expectancy, literacy, access to education and per capita gross domestic product) and the United Nations region were explored as potential sources of variation in undernutrition. The overall prevalence was 29.1% (95% CI 26.7%, 31.6%) for stunting, 6.3% (95% CI 4.6%, 8.2%) for wasting, and 13.7% (95% CI 10.9%, 16.9%) for underweight. Subgroup analyses suggested that Western Africa, Southern Asia, and Southeastern Asia had a substantially higher estimated prevalence of undernutrition than global average estimates. In multivariable meta-regression, a combination of human development index and United Nations region (a proxy for geographical variation) explained 54%, 56%, and 66% of the variation in stunting, wasting, and underweight prevalence, respectively. Our findings demonstrate that regional, subregional, and country disparities in undernutrition remain, and the residual gaps to close towards achieving the second sustainable development goal-ending undernutrition by 2030.

Project description:BackgroundThe burden of malnutrition in children under five remains an important child health issue where significant regional variations are observed in Ethiopia. The main aim of the current study was to explore the spatial distribution of stunting, wasting, and underweight in children under five in Ethiopia.MethodsThe secondary data from EDHS, 2016, was employed, and a total of 7960 under-five children were included in the analysis. The general spatial analysis was performed to explore the spatial distribution of malnutrition among under-five within and between the regions of Ethiopia. The Spatial Lag and Spatial Error models were used to examine the spatial dependence between stunting, wasting, and being underweight. The Geographically weighted regression analysis was performed to estimate the types and strength of relationships between malnutrition and associated determinant factors across the regions and within the clusters or Zones of each region.ResultsAmong the under-five children included in the study, 36.6% were stunted, 12.2% were wasted and 25.2% were underweight. The Global Moran Index's value indicates (Stunting, I = 0.3135, p-value < 0.00001, Wasting, I = 0.1948, p-value < 0.0001 and Underweight, I = 0.5291, p-value < 0.0001) that there was a significant spatial variation of malnutrition across the regions and Zones of Ethiopia. The significant source of spatial variation of malnutrition in children under five was associated with the mother's education level, drinking water facility, toilet facilities, number of children under-five in the household, household's wealth index, breastfeeding duration of the child, child size at birth, Body Mass Index of Mothers (BMI), region, and place of residence.ConclusionsThe spatial association and spatial patterns of stunting, wasting, and being underweight were clustered within and between the regions of Ethiopia. The hotspot areas of stunting, wasting, and being underweight were detected in the regions where there were poor health facilities and limited socioeconomic indicators.