Abstract
Background: Despite having better human development indicators, one-fifth of under-five children in Kerala are undernourished. The demographic, socio-economic, cultural and political transition in Kerala necessitates a revisit on the causes of undernutrition among children given that it tackled many of the immediate causes of undernutrition. The present study aims at the multi-dimensional factors' influence on nutritional status of children from low socio-economic strata in Kerala.
 Methods/Design: The conceptual framework for the present study adapted the ecosocial theory by Nancy Krieger. We use an explanatory study design, by adopting both quantitative and qualitative methods. The sample size for the quantitative phase is 600 children of age six to 60 months and their mothers. The qualitative phase includes in-depth interviews with key informants. The data collection tools include weighing scale and stadiometer for taking anthropometric measurements, household survey questionnaire, interview schedule for mothers, interview guide for key informants, field diary and checklist for document analysis.
 Discussion: Contextual evidence that the study generates will have implications at individual, service provision and policy perspectives of undernutrition among children in Kerala. It will help improve the nutrition-specific and nutrition-sensitive policies and programs in Kerala, which in turn will improve the nutritional status of the children.
Highlights
Despite having better human development indicators, one-fifth of under-five children in Kerala are undernourished
Contextual evidence that the study generates will have implications at individual, service provision and policy perspectives of undernutrition among children in Kerala. It will help improve the nutrition-specific and nutrition-sensitive policies and programs in Kerala, which in turn will improve the nutritional status of the children
Despite the time to time nutrition-specific and/or nutritionsensitive interventions such as Integrated Child Development Services (ICDS), Public Distribution System (PDS) and Mahatma Gandhi National Rural Employment Guarantee Scheme that run across the country to ensure nutrition, food insecurity and minimum income respectively, the quest of undernutrition among children in the country could not be resolved (Planning Commission, 2010)
Summary
Despite having better human development indicators, one-fifth of under-five children in Kerala are undernourished. According to the fourth National Family Health Survey (NFHS-4), conducted in 2015-16, the prevalence of stunting, underweight and wasting among Indian children were 35.4%, 35.7% and 21.0% respectively. Average annual reduction for all the three indicators since NFHS-3 (2005-06) was less than one per cent (International Institute for Population Sciences [IIPS] & Inner City Fund [ICF], 2017a). In addition to this high burden, there is high interstate and intrastate disparities throughout the country that the majority of the undernourished children belong to the six states out of 29 states and seven union territories of India. Despite the time to time nutrition-specific and/or nutritionsensitive interventions such as Integrated Child Development Services (ICDS), Public Distribution System (PDS) and Mahatma Gandhi National Rural Employment Guarantee Scheme that run across the country to ensure nutrition, food insecurity and minimum income respectively, the quest of undernutrition among children in the country could not be resolved (Planning Commission, 2010)
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