Examining Spatial Dependency in Child Malnutrition Across 640 Districts in India for Context Specific Planning and Intervention

Abstract

Abstract Objectives India, in accordance with United Nation's Sustainable Development Goals, is committed to reduce malnutrition, which accounts to 68.2% of deaths in children below 5 years in the country. The fourth round of National Family Health Survey (NFHS4) provided information on nutrition and health at district level, for the first time. The objective of this study was to investigate significant correlates that influence the nutrition outcomes, and establish a spatial relationship, if any, which would help in informing policy decisions and targeted planning, considering the vast diversity and heterogeneity across regions in India. Methods Publicly available district data from National Family Health Survey-4(2015–16) was used. Based on previous studies, 21 independent variables providing information on household conditions, maternal health and childhood diseases and deficiencies, were shortlisted. The outcome variables were stunting, wasting and underweight in children under the age of five. Principal Component Analysis was conducted to reduce the dimensions owing to multicollinearity. Moran's I Values, Ordinary least square method, spatial lag model and spatial error model were employed to study the spatial relationship using statistical tools like Stata 15 (SE), Minitab and GeoDa version 1.14.0. Results Moran's I Values of stunting (0.67), wasting (0.51) and underweight (0.76) suggest strong spatial dependency across regions in India. Spatial Error Model with lower Akaike info Criterion value was found to be a better model in comparison with ordinary least square and spatial lag model. Women's short height was found to have significant positive association with both stunting (coefficient: 0.86, P < 0.01) and underweight (coefficient: 0.66, P < 0.01). Whereas, child anaemia showed significant positive association with wasting (coefficient: 0.19, P < 0.01) and underweight (coefficient: 0.14, P < 0.01). While households using iodized salt showed a negative association with both stunting (coefficients: −0.18, P < 0.01) and underweight (Coefficient: −0.12, P < 0.01), households with improved drinking water showed negative association (coefficient: −.06, P < 0.05) with wasting. Conclusions This study confirms spatial dependency in malnutrition in India and urges the need for focused interventions to tackle malnutrition. Funding Sources None.