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A success story of reduction in childhood stunting and underweight in India: analysis of pooled data from three rounds of Indian Demographic and Health Surveys (1998–2016)

Published online by Cambridge University Press:  14 December 2020

Swati Srivastava  and
Ashish Kumar Upadhyay Open the ORCID record for Ashish Kumar Upadhyay [Opens in a new window]
Swati Srivastava
Affiliation:
International Institute for Population Sciences, Mumbai, India
Ashish Kumar Upadhyay*
Affiliation:
International Institute for Population Sciences, Mumbai, India
*
*Corresponding author. Email: ashu100789@gmail.com
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Abstract

This study used a series of individual-level datasets from National Family Health Surveys conducted in 1998–99, 2005–06 and 2015–16 to assess the factors behind the reduction in childhood stunting and underweight in India between the years 1998–99 and 2015–16. A multivariable decomposition regression analysis was performed. Results showed that the prevalence of childhood stunting declined from 49.4% in 1998–99 to 34.9% in 2015–16. Over the same period, the prevalence of childhood underweight declined from 41.9% in 1998–99 to 33.1% in 2015–16. The reduction in the prevalence of stunting was found to be contributed largely by a reduction in the combined prevalence of stunting and underweight (60%), followed by stunted only (21%) and the combined prevalence of stunting, underweight and wasting (19%). Likewise, the reduction in the prevalence of underweight was contributed by a reduction in the combined prevalence of stunting and underweight and the combined prevalence of stunting, underweight and wasting. Results of the decomposition analysis showed that over the period 1998–99 to 2015–16, improvement in wealth status and maternal education led to 13% and 12% declines, respectively, in childhood stunting and to 31% and 19% declines, respectively, in childhood underweight. Furthermore, reductions in childhood stunting and underweight were due to an increased average number of antenatal care visits, lower average birth order, decreased share of children with below-average birth size, increased use of clean fuel for cooking and a reduction in the practice of open defecation. These findings suggest that further reduction in the prevalence of childhood stunting and underweight could be attained through more equitable household economic growth, investment in girl’s education, greater access to improved toilet facilities, more widespread use of clean fuel for cooking, reduction in average birth order, increased antenatal care visits and greater consumption of IFA tablets by pregnant women. Policymakers need to prioritize these measures to further reduce malnutrition among Indian children.

Keywords

StuntingUnderweightDemographic and Health Survey
Type
Research Article
Information
Journal of Biosocial Science , Volume 54 , Issue 1 , January 2022 , pp. 106 - 123
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Adair, LS and Guilkey, DK (1997) Age–specific determinants of stunting in Filipino children. Journal of Nutrition 127(2), 314–320.10.1093/jn/127.2.314CrossRefGoogle ScholarPubMed
Amugsi, DA, Mittelmark, MB and Lartey, A (2013) An analysis of socio-demographic patterns in child malnutrition trends using Ghana Demographic and Health Survey data in the period 1993–2008. BMC Public Health 13(1), 960.CrossRefGoogle ScholarPubMed
Basu, S (2015) Unsafe water stunting growth of Indian children: report. Down To Earth, New Delhi, India.Google Scholar
Bishwakarma, R (2011) Spatial inequality in child nutrition in Nepal: implications of regional context and individual/household composition. PhD thesis, University of Maryland, USA.Google Scholar
Case, A, Lubotsky, D and Paxson, C (2002) Economic status and health in childhood: the origins of the gradient. American Economic Review 92(5), 1308–1334.10.1257/000282802762024520CrossRefGoogle ScholarPubMed
Checkley, W, Gilman, RH, Black, RE, Epstein, LD, Cabrera, L, Sterling, CR et al. (2004) Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. The Lancet 363(9403), 112–118.CrossRefGoogle Scholar
Chowdhury, MRK, Rahman, MS, Khan, MMH, Mondal, MNI, Rahman, MM and Billah, B (2016) Risk factors for child malnutrition in Bangladesh: a multilevel analysis of a nationwide population-based survey. Journal of Pediatrics 172, 194–201.10.1016/j.jpeds.2016.01.023CrossRefGoogle ScholarPubMed
Cleland, JG and Van Ginneken, JK (1988) Maternal education and child survival in developing countries: the search for pathways of influence. Social Science & Medicine 27(12), 1357–1368.CrossRefGoogle ScholarPubMed
Dearden, KA, Schott, W, Crookston, BT, Humphries, DL, Penny, ME and Behrman, JR (2017) Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam. BMC Public Health 17(1), 110.10.1186/s12889-017-4033-1CrossRefGoogle Scholar
Dessie, ZB, Fentie, M, Abebe, Z, Ayele, TA and Muchie, KF (2019) Maternal characteristics and nutritional status among 6–59 months of children in Ethiopia: further analysis of demographic and health survey. BMC Pediatrics 19(1), 83.CrossRefGoogle ScholarPubMed
Di Cesare, M, Bhatti, Z, Soofi, SB, Fortunato, L, Ezzati, M and Bhutta, ZA (2015) Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey. The Lancet Global Health 3(4), e229–e239.CrossRefGoogle ScholarPubMed
Esrey, SA (1996) Water, waste, and well-being: a multicountry study. American Journal of Epidemiology 143(6), 608–623.CrossRefGoogle ScholarPubMed
Fall, CH, Sachdev, HS, Osmond, C, Restrepo-Mendez, MC, Victora, C, Martorell, R et al. (2015) Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). The Lancet Global Health 3(7), e366–e377.CrossRefGoogle Scholar
Fink, G, Günther, I and Hill, K (2011) The effect of water and sanitation on child health: evidence from the Demographic and Health Surveys 1986–2007. International Journal of Epidemiology 40(5), 1196–1204.10.1093/ije/dyr102CrossRefGoogle ScholarPubMed
Fotso, J-C (2007) Urban–rural differentials in child malnutrition: trends and socioeconomic correlates in sub-Saharan Africa. Health & Place 13(1), 205–223.10.1016/j.healthplace.2006.01.004CrossRefGoogle ScholarPubMed
Gibbs, CM, Wendt, A, Peters, S and Hogue, CJ (2012) The impact of early age at first childbirth on maternal and infant health. Paediatric and Perinatal Epidemiology 26, 259–284.CrossRefGoogle ScholarPubMed
Haddad, L, Alderman, H, Appleton, S, Song, L and Yohannes, Y (2003) Reducing child malnutrition: How far does income growth take us? World Bank Economic Review 17(1), 107–131.CrossRefGoogle Scholar
Hasan, MT, Soares Magalhaes, RJ, Williams, GM and Mamun, AA (2016) The role of maternal education in the 15-year trajectory of malnutrition in children under 5 years of age in Bangladesh. Maternal & Child Nutrition 12(4), 929–939.10.1111/mcn.12178CrossRefGoogle ScholarPubMed
Horton, S (1999) Opportunities for Investments in Nutrition in Low-Income Asia. Asian Development Bank, Manila.Google Scholar
Howell, EM, Holla, N and Waidmann, T (2016) Being the younger child in a large African Family: a study of birth order as a risk factor for poor health using the Demographic and Health Surveys for 18 countries. BMC Nutrition 2(1), 61.10.1186/s40795-016-0100-8CrossRefGoogle Scholar
IIPS & ICF (2017) National Family Health Survey (NFHS-4), 2015–16. International Institute for Population Sciences (IIPS), Mumbai, India.Google Scholar
IIPS & ORC Macro (1995) National Family Health Survey (NFHS-1),1992–93. International Institute for Population Sciences (IIPS), Mumbai, India.Google Scholar
IIPS & ORC Macro (2000) National Family Health Survey (NFHS-2), 1998–99. International Institute for Population Sciences (IIPS), Mumbai, India.Google Scholar
IIPS & ORC Macro (2007) National Family Health Survey (NFHS-3), 2005–06. International Institute for Population Sciences (IIPS), Mumbai, India.Google Scholar
Ikeda, N, Irie, Y and Shibuya, K (2013) Determinants of reduced child stunting in Cambodia: analysis of pooled data from three demographic and health surveys. Bulletin of the World Health Organization 91, 341–349.CrossRefGoogle ScholarPubMed
Imdad, A and Bhutta, ZA (2012) Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes. Paediatric and Perinatal Epidemiology 26, 138–152.CrossRefGoogle ScholarPubMed
Kelly, MS, Wirth, KE, Madrigano, J, Feemster, KA, Cunningham, CK, Arscott-Mills, T et al. (2015) The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana. International Journal of Tuberculosis and Lung Disease 19(3), 349–355.CrossRefGoogle ScholarPubMed
Khan, J and Mohanty, SK (2018) Spatial heterogeneity and correlates of child malnutrition in districts of India. BMC Public Health 18(1), 1027.CrossRefGoogle ScholarPubMed
Kuhnt, J and Vollmer, S (2017) Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open 7(11), e017122.CrossRefGoogle ScholarPubMed
Lin, A, Arnold, BF, Afreen, S, Goto, R, Huda, TMN, Haque, R et al. (2013) Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. American Journal of Tropical Medicine and Hygiene 89(1), 130–137.CrossRefGoogle ScholarPubMed
MDS (2010) Million Death Study Collaborators: causes of neonatal and child mortality in India: a nationally representative mortality survey. The Lancet 376, 1853–1860.CrossRefGoogle Scholar
Meshram, II, Kodavanti, MR, Chitty, GR, Manchala, R, Kumar, S, Kakani, SK et al. (2015) Influence of feeding practices and associated factors on the nutritional status of infants in rural areas of Madhya Pradesh State, India. Asia Pacific Journal of Public Health 27(2), NP1345–NP1361.CrossRefGoogle Scholar
Ministry of Petroleum and Natural Gas (2016) Pradhan Mantri Ujjawala Yojana. URL: https://pmuy.gov.in/about.html Google Scholar
NRHM (2007) National Rural Health Mission: Meeting People’s Health Needs in Rural Areas: Framework for Implementation, 2005–2012. National Rural Health Mission, Ministry of Health & Family Welfare, India.Google Scholar
Powers, AD, Yoshioka, H and Yun, MS (2011) Multivariate decomposition for nonlinear response models. Stata Journal 4, 556–576.CrossRefGoogle Scholar
Rah, JH, Cronin, AA, Badgaiyan, B, Aguayo, VM, Coates, S and Ahmed, S (2015) Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys. BMJ Open 5(2), e005180.CrossRefGoogle ScholarPubMed
Rahman, M (2016) Association between order of birth and chronic malnutrition of children: a study of nationally representative Bangladeshi sample. Cadernos de saude publica 32, e00011215.CrossRefGoogle ScholarPubMed
Singh, A, Kumar, K and Singh, A (2019a) What explains the decline in neonatal mortality in india in the last three decades? Evidence from three rounds of NFHS surveys. Studies in Family Planning, 50(4), 337–355.CrossRefGoogle ScholarPubMed
Singh, A, Upadhyay, AK and Kumar, K (2017) Birth size, stunting and recovery from stunting in Andhra Pradesh, India: evidence from the Young Lives Study. Maternal and Child Health Journal, 21(3), 492–508.CrossRefGoogle Scholar
Singh, S, Srivastava, S and Upadhyay, AK (2019b) Socio-economic inequality in malnutrition among children in India: an analysis of 640 districts from National Family Health Survey (2015–16). International Journal for Equity in Health 18(1), 203.CrossRefGoogle Scholar
Smith, LC and Haddad, L (2002) How potent is economic growth in reducing undernutrition? What are the pathways of impact? New cross-country evidence. Economic Development and Cultural Change 51(1), 55–76.CrossRefGoogle Scholar
SRS (2017) Estimates of Mortality Indicators. Registrar General of India, New Delhi.Google Scholar
Subramanyam, MA, Kawachi, I, Berkman, LF and Subramanian, S (2011) Is economic growth associated with reduction in child undernutrition in India? PLoS Medicine 8(3), e1000424.CrossRefGoogle ScholarPubMed
UNICEF (2019) Joint Child Manutrition Dataset. UNICEF.Google Scholar
Upadhyay, AK Srivastava, S Mishra, V (2020) Does use of solid fuels for cooking contribute to childhood stunting? A longitudinal data analysis from low- and middle- income countries. Journal of Biosocial Science, doi: 10.1017/S0021932020000097.Google ScholarPubMed
WHO (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health. World Health Organization, Geneva.Google Scholar
WHO (2019) Level and Trends in Child Malnutrition: Key Findings of the 2019 Edition. World Health Organization, Geneva.Google Scholar
Winter, R, Pullum, T, Langston, A, Mivumbi, NV, Rutayisire, PC, Muhoza, DN et al. (2013) Trends in neonatal mortality in Rwanda, 2000–2010. DHS Further Analysis Report No. 88.Google Scholar
Yu, SH, Mason, J, Crum, J, Cappa, C and Hotchkiss, DR (2016) Differential effects of young maternal age on child growth. Global Health Action 9(1), 31171.CrossRefGoogle ScholarPubMed