Under-Five Child Growth and Nutrition Status: Spatial Clustering of Indian Districts

Abstract

Variation in human growth and the genetic and environmental factors that are influencing it have been described worldwide. The objective of this study is to assess the geographical variance of under-five nutritional status and its related covariates across Indian districts. We use the most recent fourth round of the Indian National Family Health Survey conducted in 2015–2016, which for the first time offers district level information. We employ principal component analysis (PCA) on the demographic and socio-economic determinants of childhood morbidity and conduct hierarchical clustering analysis to identify geographical patterns in nutritional status at the district level. Our results reveal strong geographical clustering among the districts of India, often crossing state borders. Throughout most of Southern India, children are provided with relatively better conditions for growth and improved nutritional status, as compared to districts in the central, particularly rural parts of India along the so called “tribal belt”. Here is also where girls are on average measured to have less weight and height compared to boys. Looking at average weight, as well as the proportion of children that suffer from underweight and wasting, north-eastern Indian districts offer living conditions more conducive to healthy child development. The geographical clustering of malnutrition, as well as below-average child height and weight coincides with high poverty, low female education, lower BMI among mothers, higher prevalence of both parity 4 + and teenage pregnancies. The present study highlights the importance of combining PCA and cluster analysis in studying variation in under-five child growth and of conducting this analysis at the district level. We identify the geographical areas, where children are under severe risk of undernutrition, stunting and wasting and contribute to formulating policies to improve child nutrition in India.