Abstract
The public health burden of nutritional deficiency and child mortality is the major challenge India is facing upfront. In this context, using National Family Health Survey, 2015–16 data, this study estimated rate of composite index of anthropometric failure (CIAF) among Indian children by their population characteristics, across states and examined the multilevel contextual determinants. We further investigated district level burden of infant and child mortality in terms of multiple anthropometric failure prevalence across India. The multilevel analysis confirms a significant state, district and PSU level variation in the prevalence of anthropometric failures. Factors like- place of residence, household’s economic wellbeing, mother’s educational attainment, age, immunization status and drinking water significantly determine the different forms of multiple anthropometric failures. Wealth status of the household and mother’s educational status show a clear gradient in terms of the estimated odds ratios. The district level estimation of infant and child mortality demonstrates that districts with higher burden of multiple anthropometric failures show elevated risk of infant and child mortality. Unlike previous studies, this study does not use the conventional indices, instead considered the CIAF to identify the exact and severe form of undernutrition among Indian children and the associated nexus with infant and child mortality at the district level.
Highlights
MethodsUnit level data from National Family Health Survey of 2015–16 (NFHS-4) has been used in this study
Characteristics No failurePlace of residence Rural Urban Wealth quintile Poorest Poor Middle Richer Richest
The social class divide of the children shows that 20% of the children belong to Scheduled Caste (SC) category and 21% of the children belong to the Scheduled Tribe (ST) category
Summary
Unit level data from National Family Health Survey of 2015–16 (NFHS-4) has been used in this study. International Institute for Population Sciences (IIPS), India being the nodal agency approved all the survey protocols. National Family Health Survey round four, 2015–16 is one of the largest demographic and health survey being carried out in 640 districts of India. The sample size of the survey constitutes of 6,99,686 women and 1,03,525 men from 6,01,509 households across India. The survey is intended to provide important indicators on population, health and nutrition. NFHS-4 adopts two stage stratified probability proportional to size sampling design where census villages and urban blocks are the first stage unit for rural and urban areas respectively, and the households are the second stage unit[21].
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