Evaluating Decadal Changes in Determinants of Early Childhood Stunting and Assessing Their Contribution to Socio-economic Disparity in Child Nutritional Status Across India
Authors: - Raup khan 
Published: February 2024

Various efforts have been made over the years to bring about reduction in child malnutrition; the latest among them involves Goal 2 of the SDGs. The SDG Target 2.2 recognizes the global dimension of the nutrition issue and aims to end all forms of malnutrition by 2030, including achieving, by 2025, (WHO, 2015). The present evidence on childhood malnutrition suggests that while improvement in maternal and child covariates have resulted in decline of childhood stunting over time. The present study aims to investigate how the effect of maternal and child covariates on early childhood malnutrition have changed over the last decade and examining the socio-economic disparity in the nutritional status of children across India. The present study utilizes data from the last two rounds of the National Family Health Survey, NFHS-3 in 2005-06 and NFHS-4 in 2015-16 of children in the age group 6-23 months for whom data on height-for-age was available from the last two rounds of the National Family Health Survey (NFHS-3 and NFHS-4). After dropping the missing and flagged cases, the total sample size was 12,507 and 68,246 children from NFHS-3 (2005-06) and NFHS-4 (2015-16), respectively. The selected indicator of childhood under nutrition for this study is stunting. The exposure variables selected for the study were child factors such as sex, age, birth order, size at birth, place of delivery, diet diversity, meal frequency and early initiation of breastfeeding. Maternal factors such as maternal education, media exposure, and mother’s BMI were taken into account. For healthcare service utilization we considered the variable of complete antenatal care. Other background characteristics like religion, caste, wealth index, place of residence and geographical region were also considered. We utilized chi-square test to test for the association of various factors with early childhood stunting followed by t-test to assess the changes in prevalence by each factor. We also carried out bivariate and multivariate logistic analysis to effect of various factors on childhood stunting. Lastly, we carried out Oaxaca decomposition to examine the contribution of the determinants of childhood stunting towards the changes in its prevalence over the last ten years. Concentration Index was calculated to examine the disparity in early childhood stunting across India for both rounds of the National Family Health Survey. The predictive probabilities were calculated for each category of the wealth index after fitting a logistic model to control for other determinants of early childhood stunting to assess the change in prevalence of stunting across each socio-economic group in the last ten years. The study reveals an overall decline in prevalence of early childhood stunting across India over the last ten years from 2005-16. However, high levels of variation continue to exist across all the states in India. The study reveals institutional delivery as the highest contributing factor for this decline. Maternal education, body mass index and complete antenatal care during pregnancy also contribute significantly to the improvement in childhood stunting