Zonal Distribution and Determinants of Stunting, Wasting, Underweight, and Thinness among the Indian Under-Five Children: Findings from NFHS-5

Background: The United Nations adopted the Sustainable Development Goals (SDGs) in 2015 with the aim of reducing the mortality rate for children under-five by at least 25 per 1000 live births worldwide. Four years later in 2019, about 824,000 children died in India before their fifth birthday, the second-highest number worldwide. Most of them were due to undernutrition. Objective: The objective of the study was to estimate the prevalence of undernutrition among under-five children throughout India’s various zones as well as to find its contributing factors. Methods: The National Family Health Survey, India 2019–21 (NFHS-5) provided data on undernutrition and related variables of 221,364 under-five children. Undernutrition in children was measured by stunting, wasting, underweight, and thinness. Socio-demographic and maternal characteristics were taken into consideration as influential factors. In order to determine the effect of these factors on childhood undernutrition, binary logistic regression was applied. Results: The analysis clearly showed that stunting was more prevalent in the East (38.51%) zone, whereas wasting (25.40%) underweight (37.26%) and thinness (23.07%) were more prevalent in the West zone. Children in each zone were found to have lower mean z-scores compared to WHO standards, indicating poor nutritional status. In all the zones, stunting and underweight were more common in anemic children. Undernutrition was more likely to occur in children whose mothers had lower educational attainment. The risk of undernutrition was higher in children from the scheduled caste (SC) and scheduled tribe (ST) communities. The children from poor families were more prone to be undernourished than children from wealthier families. Conclusions: Improvement initiatives such as those targeting child anemia, maternal education, tribal health, and family wealth index have been proposed as receiving major consideration. The study suggests that in order to achieve the SDGs before 2030, the Indian government should take effective steps to improve child health.