Abstract

Background:High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods:The last round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results:Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence before six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of all crops (except other millets). The analysis was limited by lack of fine-scale data on prevalence of low birth-weight and type of cereal consumed. Conclusions:Better cereal cultivation and consumption data will be needed to confirm causal pathways contributing to potential ecogeographic patterns. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.

Highlights

  • High prevalence of maternal malnutrition, low birthweight and child malnutrition in India contribute substantially to the global malnutrition burden

  • Based on unpublished field observations of wasting prevalence among populations depending on millet as staple in rural Maharashtra, we critically examined the spatial patterns of prevalence of stunting and wasting at the district level across India with the objective of exploring the role of dietary staple cereal consumption pattern using cultivation pattern as a Proxy

  • In all, 107 districts had a high prevalence of stunting with risk concentrated in poorer states: Uttar Pradesh (31; 29%) Bihar (28; 26%) and Madhya Pradesh (13; 12%)

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Summary

Introduction

High prevalence of maternal malnutrition, low birthweight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet version 3 (revision)

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