Reducing childhood stunting in India: Insights from four subnational success cases.
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ABSTRACT: Supplementary information
The online version contains supplementary material available at 10.1007/s12571-021-01252-x.
SUBMITTER: Avula R
PROVIDER: S-EPMC8975447 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:In many developing countries, high levels of child undernutrition persist alongside rapid economic growth. There is considerable interest in the study of countries that have made rapid progress in child nutrition to uncover the driving forces behind these improvements. Cambodia is often cited as a success case having reduced the incidence of child stunting from 51% to 34% over the period 2000 to 2014. To what extent is this success driven by improvements in the underlying determinants of nutrition, such as wealth and education, ("covariate effects") and to what extent by changes in the strengths of association between these determinants and nutrition outcomes ("coefficient effects")? Using determinants derived from the widely-applied UNICEF framework for the analysis of child nutrition and data from four Demographic and Health Surveys datasets, we apply quantile regression based decomposition methods to quantify the covariate and coefficient effect contributions to this improvement in child nutrition. The method used in the study allows the covariate and coefficient effects to vary across the entire distribution of child nutrition outcomes. There are important differences in the drivers of improvements in child nutrition between severely stunted and moderately stunted children and between rural and urban areas. The translation of improvements in household endowments, characteristics and practices into improvements in child nutrition (the coefficient effects) may be influenced by macroeconomic shocks or other events such as natural calamities or civil disturbance and may vary substantially over different time periods. Our analysis also highlights the need to explicitly examine the contribution of targeted child health and nutrition interventions to improvements in child nutrition in developing countries.
| S-EPMC5029902 | biostudies-literature
Project description:ObjectivesApproximately one-third of the world's stunted (low height-for-age) preschool-aged children live in India. The success of interventions designed to tackle stunting appears to vary by location and depth of poverty. We developed small-area estimation models to assess the potential impact of increments in household income on stunting across the country.DesignTwo nationally representative cross-sectional datasets were used: India's National Family Health Survey 4 (2015-2016) and the 68th round of the National Sample Survey on consumer expenditure. The two datasets were combined with statistical matching. Gaussian process regressions were used to perform geospatial modelling of 'stunting' controlling for household wealth and other covariates.Setting and participantsThe number of children in this sample totalled 259 627. Children with implausible height-for-age z-scores (HAZs) >5 or <-5, or missing data on drinking water, sanitation facility, mother's education, or geolocation and children not residing in mainland India were excluded, resulting in 207 695 observations for analysis.ResultsA monthly transfer of ~$7 (500 Indian rupees) per capita to every household (not targeted or conditional) was estimated to reduce stunting nationally by 3.8 percentage points on average (95% credible interval: 0.14%-10%), but with substantial variation by state. Estimated reduction in stunting varied by wealth of households, with the poorest quintile being likely to benefit the most.ConclusionImproving household income, which can be supported through cash transfers, has the potential to significantly reduce stunting in parts of India where the burdens of both stunting and poverty are high. Modelling shows that for other regions, income transfers may raise incomes and contribute to improved nutrition, but there would be a need for complementary activities for alleviating stunting. While having value for the country as a whole, impact of income gained could be variable, and underlying drivers of stunting need to be tackled through supplementary interventions.
| S-EPMC8984000 | biostudies-literature
Project description:BackgroundGlobally, India is home to every third child affected by stunting. While numerous studies have examined the correlates of childhood stunting (CS) in India, most of these studies have focused on examining the role of proximal factors, and the role of contextual factors is much less studied. This study presents a comprehensive picture of both proximal and contextual determinants of CS in India, expanding the current evidence base. The present study is guided by the WHO conceptual framework, which outlines the context, causes, and consequences of CS.Data and methodsThe study used exploratory spatial data analysis tools to analyse the spatial pattern and correlates of CS, using data from the fourth round (2015-16) of the National Family Health Survey (NFHS-4) and the 2011 Census of India.ResultsThe study findings reiterate that CS continues to be high in India, with several hot spot states and districts, and that children from the central and eastern region of the nation, namely, Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh are particularly vulnerable. Our analysis has identified six risk factors-maternal short stature, large household size, closely spaced births, prevalence of hypertension among women, household poverty, open defecation, and extreme temperature-and four protective factors-female education, access to improved drinking water, dietary diversity among children, and iron and folic acid (IFA) supplementation during pregnancy.ConclusionsThe study highlights the need for investing in pre-conception care, addressing both demand- and supply-side barriers to increase the coverage of nutrition-specific interventions, implementing programmes to promote the intake of healthy foods from an early age, providing contraceptive counselling and services to unmarried and married adolescents and young women and men, and universalizing quality primary and secondary education that is inclusive and equitable to avert the burden of childhood stunting in India.
| S-EPMC7446880 | biostudies-literature
Project description:[This corrects the article DOI: 10.1371/journal.pone.0237661.].
| S-EPMC7592729 | biostudies-literature
Project description:The Lives Saved Tool (LiST) has been used to estimate the impact of scaling up intervention coverage on undernutrition and mortality. Evidence for the model is largely based on efficacy trials, raising concerns of applicability to large-scale contexts. We modelled the impact of scaling up health programs in India between 2006 and 2016 and compared estimates to observed changes. Demographics, intervention coverage and nutritional status were obtained from National Family and Health Survey 2005-6 (NFHS-3) for the base year and NHFS-4 2015-16 for the endline. We used the LiST to estimate the impact of changes in coverage of interventions over this decade on child mortality and undernutrition at national and subnational levels and calculated the gap between estimated and observed changes in 2016. At the national level, the LiST estimates are close to the actual values of mortality for children <1?year and <5?years in 2016 (at 41 vs 42.6 and 50 vs 56.4, respectively, per 1000 live births). National estimates for stunting, wasting and anaemia at are also close to the actual values of NFHS-4. At the state level, actual changes were higher than the changes from the LiST projections for both mortality and stunting. The predicted changes using the LiST ranged from 33% to 92% of the actual change. The LiST provided national projections close to, albeit slightly below, actual performance over a decade. Reasons for poorer performance of state-specific projections are unknown; further refinements to the LiST for subnational use would improve the usefulness of the tool.
| S-EPMC6880331 | biostudies-literature
Project description:Despite rapid macro-economic growth, one-third of the global burden of childhood stunting is contributed by India. This burden is characterized by wide-spread geographical variation within the country. This paper explores two research questions: (i) are the drivers of severe and moderate stunting similar? (ii) differential endowments or policy-effect, how do community-level nutrition and sanitary practices affect inter-state differences? Using data from Indian National Family and Health Survey 4, 2015-16, six states holding different ranks in the stunting continuum are compared to Tamil Nadu, taken as the benchmark state due to its laudable performance in the health care sector. Applying quantile regression approaches, the difference in state-level performance is decomposed into detailed covariate effects (differential endowments) and coefficient effects (differential strength of association between the drivers and outcome). The explanatory variables are not similarly associated with severe and moderate stunting. Decomposition results demonstrate a significant role of community-level sanitation practices compared to child nutrition behaviour in explaining the inter-state disparity. Coefficient effects play a dominant role in the lower tail of HAZ distribution for the poor performing states indicating that the worse outcomes of these states are due to weaker policy effects of the control variables on stunting. Multi-sectoral approach, identification and differentiation between severe and moderate stunting cases can be more instrumental in managing and reducing the scourge. This paper also advocates the potential benefits of customizing centrally-launched policies as per the state's performance and introducing the concept coproduction in the existing nutrition and health policy framework. This will instigate a feeling of ownership of the problem of childhood stunting among the policy consumers and strengthen the influence of policies on the outcomes.
| S-EPMC7462311 | biostudies-literature
Project description:IntroductionSocioeconomic status (SES) scales measure poverty, wealth and economic inequality in a population to guide appropriate economic and public health policies. Measurement of poverty and comparison of material deprivation across nations is a challenge. This study compared four SES scales which have been used locally and internationally and evaluated them against childhood stunting, used as an indicator of chronic deprivation, in urban southern India.MethodsA door-to-door survey collected information on socio-demographic indicators such as education, occupation, assets, income and living conditions in a semi-urban slum area in Vellore, Tamil Nadu in southern India. A total of 7925 households were categorized by four SES scales-Kuppuswamy scale, Below Poverty Line scale (BPL), the modified Kuppuswamy scale, and the multidimensional poverty index (MDPI) and the level of agreement compared between scales. Logistic regression was used to test the association of SES scales with stunting.FindingsThe Kuppuswamy, BPL, MDPI and modified Kuppuswamy scales classified 7.1%, 1%, 5.5%, and 55.3% of families as low SES respectively, indicating conservative estimation of low SES by the BPL and MDPI scales in comparison with the modified Kuppuswamy scale, which had the highest sensitivity (89%). Children from low SES classified by all scales had higher odds of stunting, but the level of agreement between scales was very poor ranging from 1%-15%.ConclusionThere is great non-uniformity between existing SES scales and cautious interpretation of SES scales is needed in the context of social, cultural, and economic realities.
| S-EPMC4973914 | biostudies-literature
Project description:To curb the initial spread of SARS-CoV-2, many countries relied on nation-wide implementation of non-pharmaceutical intervention measures, resulting in substantial socio-economic impacts. Potentially, subnational implementations might have had less of a societal impact, but comparable epidemiological impact. Here, using the first COVID-19 wave in the Netherlands as a case in point, we address this issue by developing a high-resolution analysis framework that uses a demographically stratified population and a spatially explicit, dynamic, individual contact-pattern based epidemiology, calibrated to hospital admissions data and mobility trends extracted from mobile phone signals and Google. We demonstrate how a subnational approach could achieve similar level of epidemiological control in terms of hospital admissions, while some parts of the country could stay open for a longer period. Our framework is exportable to other countries and settings, and may be used to develop policies on subnational approach as a better strategic choice for controlling future epidemics.
| S-EPMC10023153 | biostudies-literature
Project description:The four rounds of National Family Health Survey (NFHS) conducted during 1992-93, 1998-99, 2005-06 and 2015-16 is main source to track the health and development related indicators including nutritional status of children at national and state level in India. Except NFHS-4, first three rounds of NFHS were unable to provides district-level estimates of childhood stunting due to the insufficient sample sizes. The small area estimation (SAE) techniques offer a viable solution to overcome the problem of small sample size. Therefore, this study uses SAE techniques to derive district level prevalence of childhood stunting corresponding to NFHS-2 (1998-99). Study further estimated GIS maps, univariate Local indicator of spatial autocorrelation (LISA) and Moran's I to understand the trend in district level childhood stunting between NFHS-2 and NFHS-4. Estimates obtained by SAE techniques suggest that prevalence of childhood stunting ranges from 20.7% (95% CI: 18.8-22.7) in South Goa district of Goa to 64.4% (95%CI: 63.1-65.7) in Dhaulpur district of Rajasthan during 1998-99. The diagnostic measures used to validate the reliability of estimates obtained by SAE techniques indicate that the model-based estimates are reliable and representative at district level. Results of geospatial analysis indicates substantial reduction in childhood stunting between 1998 and 2016. Out of 640 district,about 81 district experience reduction of more than 50%. At the same time 60 district experience less than 10% of reduction between 1998 and 2016. Spatial clustering of childhood stunting remains same over the study period except few additional cluster in Maharashtra, Andhra and Meghalaya in 2016. The district level estimates obtained from this study might be helpful in framing decentralized policies and implementation of vertical programs to enhance the efficacy of various nutrition interventions in priority districts of the country.
| S-EPMC8093462 | biostudies-literature
Project description:The longitudinal relationship between stunting and wasting in children is poorly characterized. Instances of wasting or poor weight gain may precede linear growth retardation. We analyzed longitudinal anthropometric data for 1599 children from 8 cohort studies to determine the effect of wasting [weight-for-length Z-score (WLZ) < -2] and variability in WLZ in the first 17 mo on length-for-age Z-score (LAZ) at 18-24 mo of age. In addition, we considered the effects of change in WLZ during the previous 6-mo period on length at 18 and 24 mo. Wasting at 6-11 or 12-17 mo was associated with decreased LAZ; however, children who experienced wasting only at 0-5 mo did not suffer any long-term growth deficits compared with children with no wasting during any period. Children with greater WLZ variability (?0.5 SD) in the first 17 mo of life were shorter [LAZ = -0.51 SD (95% CI: -0.67, -0.36 SD)] at 18-24 mo of age than children with WLZ variability <0.5. Change in WLZ in the previous 6-mo period was directly associated with greater attained length at 18 mo [0.33 cm (95% CI: 0.11, 0.54 cm)] and 24 mo [0.72 cm (95% CI: 0.52, 0.92 cm)]. Children with wasting, highly variable WLZ, or negative changes in WLZ are at a higher risk for linear growth retardation, although instances of wasting may not be the primary cause of stunting in developing countries.
| S-EPMC3374667 | biostudies-literature