Projecting stunting and wasting under alternative scenarios in Odisha, India, 2015–2030: a Lives Saved Tool (LiST)-based approach

Abstract

ObjectiveAlthough nutrition-specific interventions are designed based on maternal, household and community-level correlates, no attempt has been made to project stunting and wasting and identify intervention priorities in India. The objective of this paper is to model the stunting and wasting in the state of Odisha, India by scaling up maternal and child health interventions under alternative scenarios.DesignThis study primarily used data from National Family Health Survey 4, 2015–2016.MeasuresThe LiST (Lives Saved Tool) software is used to model the nutritional outcomes and prioritise interventions. The projections were carried out under four alternative scenarios: scenario 1—if the coverage indicators continued based on past trends; scenario 2—scaled up to the level of the richest quintile; scenario 3—scaled up to that of Tamil Nadu; and scenario 4—scaled up to an aspirational coverage level.ResultsIn 2015, out of 3.52 million under-5 children in Odisha, around 1.20 million were stunted. By 2030, the numbers of stunted children will be 1.11 million under scenario 1, 1.07 million under scenario 2, 1.09 million under scenario 3 and 0.89 million under scenario 4. The projected stunting level will be 25% under scenario 4 and around 31% under all other scenarios. By 2030, the level of wasting will remain unchanged at 20% under the first three scenarios and 4.3% under scenario 4. Appropriate complementary feeding would avert about half of the total stunting cases under all four scenarios, followed by zinc supplementation. Water connection at home, washing hands with soap and improved sanitation are other effective interventions.ConclusionSustaining the maternal and child health interventions, promoting evidence-based stunting and wasting reduction interventions, and a multisectoral approach can achieve the World Health Assembly targets and Sustainable Development Goals of undernutrition in Odisha.

Disparity in childhood stunting in India: Relative importance of community-level nutrition and sanitary practices

“…Weak association of community-level sanitation practices with stunting outcomes contributed majorly in explaining the worse performance of these states in comparison to Tamil Nadu. Studies assessing drivers of inter-regional HAZ differences advocate that child feeding practices and nutrition behavior directly contribute to improving the performance of one region against another in developing countries [ 18 , 19 , 32 ]. However, at the community level, the disease environment manifested through sanitation practices, is a vital driver in elucidating inter-state differences.…”

“…Results from decomposition imply that sanitation practices along with improvement in maternal endowments and household SES can assist in further improvement in Odisha. A study suggests, Odisha could avert a substantial number of stunting cases by 2030 if the state scaled-up their sanitation practices to the standards of Tamil Nadu [ 18 ]. Post green revolution in the 1960s, Punjab has witnessed rapid agricultural growth along with an increase in per capita income and lower levels of calorie-related undernourishment [ 74 ].…”

“…The persistently high levels of childhood stunting in states like Bihar, Uttar Pradesh, and Madhya Pradesh are a concern not only from a social, political, and public health standpoint but also because these states are projected to contribute the maximum to the future population growth in India [14]. On the other hand, Tamil Nadu is lauded for its superior performance in several public health fronts and often portrayed as the best practices state [15][16][17][18][19]. It has been successful in reducing childhood stunting level to 27% in 2015-16, which is comparable to many better performing middle-income countries of South-East Asia [2].…”

Factors influencing delivery of intersectoral actions to address infant stunting in Bogotá, Colombia – a mixed methods case study.

“…A further conceptual point for discussion regarding differences between intersectoral and multisectoral interventions for stunting arises from the analysis of factors that condition ISA. Nutrition-speci c interventions rely on the health sector (7) but there is ample recognition that many additional sectors have roles to play in nutrition-sensitive interventions (11,(30)(31)(32). During planning and implementation of the intervention against stunting in Bogotá, a lack of engagement of the health sector was frequently seen as a barrier for ISA.…”

Factors influencing delivery of intersectoral actions to address infant stunting in Bogotá, Colombia – a mixed methods case study

“…A further conceptual point for discussion regarding differences between intersectoral and multisectoral interventions for stunting arises from the analysis of factors that condition ISA. Nutrition-specific interventions rely on the health sector [7] but there is ample recognition that many additional sectors have roles to play in nutrition-sensitive interventions [11,[29][30][31]. During planning and implementation of the intervention against stunting in Bogotá, a lack of engagement of the health sector was frequently seen as a barrier for ISA.…”