An intersectional analysis of the composite index of anthropometric failures in India

Abstract

Background Nutritional inequality in India has been estimated typically using stunting, wasting and underweight separately which hide the overall magnitude and severity of undernutrition. We used the Composite Index of Anthropometric Failure (CIAF) that combines all three forms of anthropometric failures to assess the severity of undernutrition and identify the most vulnerable social groups and geographical hotspots. Method CIAF was constructed using child anthropometric data from the fourth round of the National Family Health Survey (NFHS-4, 2015–16). We considered 24 intersecting sub-groups based on intersections across four main axes of inequality i.e., caste [Scheduled Tribe (ST), Scheduled Caste (SC) and Other], economic position (poor and non-poor), place of residence (rural and urban) and gender (male and female) (eg. ST-Poor-Rural-Female). Cross-tabulation and logistic regression were done to assess the odds of CIAF among intersecting groups and to identify the most vulnerable sub-groups. Concentration curve was plotted to visualise economic position inequality in child undernutrition across caste categories. Choropleth maps were constructed and descriptive analysis of the district-level prevalence of CIAF was performed to identify the geographic clustering of undernutrition. Results Overall 55.32% of children were undernourished by CIAF and 6.62% of children have simultaneous three anthropometric failure. In sub-group analysis, children from ST and SC caste have a higher risk of undernutrition irrespective of other axis of inequality. Compared with CIAF, economic position inequality was amplified for simultaneous-three-failures among all caste categories. Economic position inequalities within caste are more for other caste and SC categories than with ST. Economic position, caste and gender based inequality in all three failures is more consistent in rural areas than with urban areas. Based on the analysis of the high prevalence in the co-occurrence of two or three failures, 111 districts from 12 of 29 states in India were identified across four geographic clusters. Conclusions The study shows social and eco-geographical clustering of multi-dimensional anthropometric failures and indicates the need for focused nutritional interventions among SC and ST community in general and ST children from the poor households. Furthermore, governance interventions that target entire regions across districts and states combined with decentralised planning are needed.

Extent of Nutritional failure among under-five children from an urban slum in South India: A cross-sectional assessment using Composite index of Anthropometric failure

“…The rationale for this nding may be that educated fathers are better able to provide for the family's nutritional needs since they may be more aware of what their children need in terms of nutrition. Many studies found age of child, mother's age, unimmunized kids, high birth order, large family size, nuclear family, low SES,, early initiation of breast feeding, maternal early marriage, domestic violence and morbidities to be predictors of CIAF which have not been found in our study (10)(11)(12)(13)(16)(17)(18).…”

Urban-rural differences in the associated factors of severe under-5 child undernutrition based on the composite index of severe anthropometric failure (CISAF) in Bangladesh

“…Poor parents often cannot afford a minimum diet and proper postnatal care for their children [ 41 ]. Other plausible explanations, such as increased clustering of urban poor in slums with limited access to public health and nutrition services and amenities, high population density, poor quality drinking water, inadequate sanitation facilities, are also blameworthy for the higher prevalence of severeundernutrition among the under-5 children of the poor households [ 42 ].…”

Alarming level of severe acute malnutrition in Indian districts

“…In this section we outlined the changes in SAM prevalence in districts identified as hotspots for malnutrition based on a comprehensive analysis using the CIAF by Kochupurackal et al 10. Kochupurackal et al identified 111 districts clustered in four malnutrition hotspots in India that requires urgent policy intervention.…”

“…SAM prevalence in NFHS-4 and NFHS-5 surveys was categorised as low, medium, high, very high and critical prevalence based on district-level mean prevalence and SD. Additionally, we examined the prevalence trend in SAM in the 111 undernutrition hotspot districts identified using the Composite Index of Anthropometric Failures (CIAF) based on the NFHS-4 data 10. Finally, the district level data set for SAM prevalence from NHFS-4 and NFHS-5 survey was linked with India spatial database with district boundaries in Quantum Geographic Information Systen(QGIS) open source software.…”

“…(A) District level undernutrition hotspot based on the high prevalence of simultaneous two and three anthropometric failures (NFHS-4) (source:10). (B) Changes in SAM prevalence in undernutrition hotspots (NFHS-5).…”