Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993–2021

poor diets, it is imperative that countries prioritize efforts to strengthen social behavior change and communications to increase awareness among parents and caregivers of the importance of complementary foods along with culturally specific guidelines on the preparation of nutritious, complementary foods. While achievement of a minimum dietary diversity may be beyond the means of some families, there are ways to increase the nutrient density of diets, such as adding critical vitamins and minerals through fortification of staple foods like wheat, maize, rice, and other cereals that constitute the main source of dietary energy in many low-income households. 8 Similarly, use of iodized salt is a low-cost way to ensure optimal intake of iodine. These data provide a bleak picture of the challenges facing millions of young children and should spur policy makers to prioritize ensuring that the youngest and most vulnerable segments of their countries' populations achieve their full potential to thrive.

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confidence: 69%

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confidence: 92%

Prevalence of Inadequate Nutrition Among Children Aged 6 to 23 Months in Low- and Middle-Income Countries

Gorstein,

Pak-Gorstein

2024

“…Fourth, the study relied on aggregated, national-level data, which may have masked within-country variations. For example, a recent study found large differences in zero-food prevalence across states in India . Subnational disparities in zero-food prevalence and associated factors may exist, which could have important implications for targeted interventions.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries

Karlsson,

Kim,

Subramanian

2024

Self Cite

ImportanceThe introduction of solid or semisolid foods alongside breast milk plays a vital role in meeting nutritional requirements during early childhood, which is crucial for child growth and development. Understanding the prevalence of zero-food children (defined for research purposes as children aged 6 to 23 months who did not consume animal milk, formula, or solid or semisolid food during the last 24 hours) is essential for targeted interventions to improve feeding practices.ObjectiveTo estimate the percentage of zero-food children in 92 low- and middle-income countries.Design, Setting, and ParticipantsThis cross-sectional study analyzed nationally representative cross-sectional household data of children aged 6 to 23 months from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys conducted between May 20, 2010, and January 27, 2022. Data were obtained from 92 low- and middle-income countries. Standardized procedures were followed to ensure data comparability and reliability. Both percentage and number of zero-food children were estimated.Main Outcomes and MeasuresThe outcome studied was defined as a binary variable indicating children aged 6 to 23 months who had not been fed any animal milk, formula, or solid or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker.ResultsA sample of 276 379 children aged 6 to 23 months (mean age, 14.2 months [95% CI, 14.15-14.26 months]) in 92 low- and middle-income countries was obtained, of whom 51.4% (95% CI, 51.1%-51.8%) were boys. The estimated percentage of zero-food children was 10.4% (95% CI, 10.1%-10.7%) in the pooled sample, ranging from 0.1% (95% CI, 0%-0.6%) in Costa Rica to 21.8% (95% CI, 19.3%-24.4%) in Guinea. The prevalence of zero-food children was particularly high in West and Central Africa, where the overall prevalence was 10.5% (95% CI, 10.1%-11.0%), and in India, where the prevalence was 19.3% (95% CI, 18.9%-19.8%). India accounted for almost half of zero-food children in this study.Conclusions and RelevanceIn this cross-sectional study of 276 379 children aged 6 to 23 months, substantial disparities in the estimates of food consumption across 92 low- and middle-income countries were found. The prevalence of zero-food children underscores the need for targeted interventions to improve infant and young child feeding practices and ensure optimal nutrition during this critical period of development. The issue is particularly urgent in West and Central Africa and India.

“…Existing research on the high prevalence of food deprivation among young children in India suggests that the mortality burden during the postneonatal period could be substantial . For instance, about 30% of children aged 6 to 12 months (ie, the latter half of the postneonatal period) were reported to have not consumed any food for the 24 hours before the survey .…”

Section: Discussionmentioning

confidence: 99%

“…This was necessary as the geometry and number of states and UTs changed over the survey years, with the latest configuration being 28 states and 8 UTs. To make states and UTs comparable over time, we adopted a published method that entailed reassigning district-level information from older surveys to states according to the most recent geometry . The NFHS data were collected using informed consent and the protocol for the survey, including the content of all the questionnaires, was approved by the International Institute for Population Studies Institutional Review Board (IRB) and the ICF IRB.…”

Section: Methodsmentioning

confidence: 99%

Early-Neonatal, Late-Neonatal, Postneonatal, and Child Mortality Rates Across India, 1993-2021

Subramanian,

Kumar,

Pullum

et al. 2024

Self Cite

ImportanceThe global success of the child survival agenda depends on how rapidly mortality at early ages after birth declines in India, and changes need to be monitored to evaluate the status.ObjectiveTo understand the disaggregated patterns of decrease in early-life mortality across states and union territories (UTs) of India.Design, Setting, and ParticipantsRepeated cross-sectional data from the 5 rounds of the National Family Health Survey conducted in 1992-1993, 1998-1999, 2005-2006, 2015-2016, and 2019-2021 were used in a representative population-based study. The study was based on data of children born in the past 5 years with complete information on date of birth and age at death. The analysis was conducted in February 2024.ExposureTime and geographic units.Main Outcomes and MeasuresMortality rates were computed for 4 early-life periods: early-neonatal (first 7 days), late-neonatal (8-28 days), postneonatal (29 days to 11 months), and child (12-59 months). For early and late neonatal periods, the rates are expressed as deaths per 1000 live births, for postneonatal, as deaths per 1000 children aged at least 29 days and for child, deaths per 1000 children aged at least 1 year. These are collectively mentioned as deaths per 1000 for all mortalities. The relative burden of each of the age-specific mortalities to total mortality in children younger than 5 years was also computed.ResultsThe final analytical sample included 33 667 (1993), 29 549 (1999), 23 020 (2006), 82 294 (2016), and 64 242 (2021) children who died before their fifth birthday in the past 5 years of each survey. Mortality rates were lowest for the late-neonatal and child periods; early-neonatal was the highest in 2021. Child mortality experienced the most substantial decrease between 1993 and 2021, from 33.5 to 6.9 deaths per 1000, accompanied by a substantial reduction in interstate inequalities. While early-neonatal (from 33.5 to 20.3 deaths per 1000), late-neonatal (from 14.1 to 4.1 deaths per 1000), and postneonatal (from 31.0 to 10.8 deaths per 1000) mortality also decreased, interstate inequalities remained notable. The mortality burden shifted over time and is now concentrated during the early-neonatal (48.3% of total deaths in children younger than 5 years) and postneonatal (25.6%) periods. A stagnation or worsening for certain states and UTs was observed from 2016 to 2021 for early-neonatal, late-neonatal, and postneonatal mortality. If this pattern continues, these states and UTs will not meet the United Nations Sustainable Development Goal targets related to child survival.Conclusions and RelevanceIn this repeated cross-sectional study of 5 time periods, the decrease in mortality during early-neonatal and postneonatal phases of mortality was relatively slower, with notable variations across states and UTs. The findings suggest that policies pertaining to early-neonatal and postneonatal mortalities need to be prioritized and targeting of policies and interventions needs to be context-specific.