Reducing stunting in India: what investments are needed?

Avula, Rasmi; Raykar, Neha; Menon, Purnima; Laxminarayan, Ramanan

doi:10.1111/mcn.12291

Cited by 16 publications

(18 citation statements)

References 5 publications

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“…Peru achieved dramatic success in reducing stunting and improving childhood nutrition between 2005 and 2011, which has been attributed to a combination of factors, including a shift in national nutrition policy, engagement of civil society, and poverty reduction (Mejía Acosta & Haddad, ). In India, although large national programs have been implemented to improve child nutrition, challenges related to the complexity of the interventions identified often leads to gaps in implementation (Avula, Raykar, Menon, & Laxminarayan, ). Large‐scale childhood nutrition programs have also been implemented in Ethiopia and Vietnam (Lemma & Matji, ; Piwoz, Baker, & Frongillo, ), with Ethiopia experiencing an overall decline in childhood stunting from 58% to 44% between the years of 2000 and 2011 (Central Statistical Agency [Ethiopia] & ICF International, ).…”

Section: Discussionmentioning

confidence: 99%

“…Our results also indicate that there is considerable variation across the four study countries in terms of child growth trajectories, which may suggest the importance of environmental context. Ethiopia and often leads to gaps in implementation (Avula, Raykar, Menon, & Laxminarayan, 2016). Large-scale childhood nutrition programs have also been implemented in Ethiopia and Vietnam (Lemma & Matji, 2013;Piwoz, Baker, & Frongillo, 2013) Although previous studies indicate that the first 1,000 days is critical for healthy long-term development through later childhood, stunting in later childhood may also carry with it long-term health and development challenges (Rockers & Fink, 2014); however, research remains limited in this area.…”

Section: Figurementioning

confidence: 99%

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Stunting trajectories from post‐infancy to adolescence in Ethiopia, India, Peru, and Vietnam

Gausman

Kim

Subramanian

2019

Maternal & Child Nutrition

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Many interventions focus on preventing stunting in the first 1,000 days of life. We take a broader perspective on childhood growth to assess the proportions of children who suffer persistent stunting, recover, and falter and become newly stunted between birth and adolescence. We use longitudinal data collected on 7,128 children in Ethiopia, India, Peru, and Vietnam. Data were collected in five survey waves between the ages of 1 to 15 years. We use descriptive and graphical approaches to compare the trajectories of children first stunted by age 1, first stunted by age 5, and those remained not stunted until age 5. On average, 29.6% of children were first stunted by age 1, 12.9% of children were first stunted by the age 5, and 68.7% of children were not stunted at either age 1 or age 5. A larger percentage of children stunted by age 1 remained stunted at age 15 (40.7%) compared with those who were first stunted by age 5 (32.3%); 33.7% of children first stunted by age 1 and 31.1% of children first stunted by age 5 go on to recover, but then falter during later childhood. 13.1% of children who were not stunted at age 1 or age 5 become newly stunted between the ages of 8 and 15. Our results show that children both become stunted and recover from stunting into adolescence. More attention should be paid to interventions to support healthy growth throughout childhood.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Stunting trajectories from post‐infancy to adolescence in Ethiopia, India, Peru, and Vietnam

Gausman

Kim

Subramanian

2019

Maternal & Child Nutrition

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“…In South Asia, nutritional programs, health insurance, and access to health services have improved nutritional outcomes (Gillespie et al 2017;Kohli et al 2017;Nisbett et al 2017). Economic growth can support better nutrition, albeit the effect varies (Headey 2012) and households with adequate income may still have undernourished members (Avula et al 2016). In South Asia, gender-related social norms including mother's early marriage, early pregnancy (Coffey 2015), and position within a joint family (Coffey et al 2017) and children's gender (i.e., son preference) (Raj et al 2015), birth order and birth interval (Headey et al 2015), preferential food allocation (Munro and McIntyre 2014) all influence children's nutritional outcomes.…”

Section: Factors Contributing To Child Undernutrition In South Asiamentioning

confidence: 99%

“…Research on intrahousehold bargaining models indicates that we should not presume that resources are equitably distributed within households (Alderman et al 1995). Nor should we assume that nutritional achievements are equitably distributed within households (Haddad and Kanbur 1990;Marcoux 2002;Avula et al 2016). An emergent literature has highlighted the limitations of relying on household level and child-level nutrition estimates.…”

Section: Intrahousehold Variation In Undernutrition In South Asiamentioning

confidence: 99%

Last and least: Findings on intrahousehold undernutrition from participatory research in South Asia

Lentz

Narayanan

De³

2019

Social Science & Medicine

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In this paper, we analyze intrahousehold mechanisms that rural South Asian women themselves identify as contributing to their inabilities to achieve adequate nutrition. The majority of our female respondents explain that, within their families, they are most likely to eat least and last and to seek lower quality healthcare later, both of which can lead to undernutrition. We consider the explanations that women provide for why they do so. In addition to norm abidance, we highlight two social factors: a partner's heavy alcohol use and intimate partner violence. Women report that these factors adversely impact their own health and food security status and potentially contribute to differential nutritional outcomes within the same household. The emic perspectives presented here show us: (1) many rural South Asian women report shouldering a relatively greater share of food and nutrition insecurity within their households, and (2) taking their perspectives seriously assists in identifying the underlying contributors to intrahousehold differences. These findings indicate the value a gendered perspective on both the drivers of and measurement of undernutrition. Attending to these intrahousehold factors in future quantitative research may provide important insights for understanding drivers of nutritional outcomes.

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“…India has made progress in reducing undernutrition, but the prevalence of child undernutrition remains strikingly high: 38% of children under 5 years of age are stunted (height-for-age z-score < -2 standard deviations, SD), 21% are wasted (weight-for-height z -score < -2 SD), and 58% are anaemic [ 5 ]. In addition, almost a quarter of Indian women aged 15–49 are underweight and more than half are anaemic [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial

Kadiyala

Prost

Harris‐Fry

et al. 2018

Trials

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BackgroundMaternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. ‘Nutrition-sensitive’ agriculture programs could tackle the underlying causes of undernutrition.Methods/designThis study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women’s groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women’s groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women’s groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6–23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0–23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children’s weight-for-height z-score < -2 standard deviations (SD).The unit of randomisation is a cluster, defined as one or more villages with a combined minimum population of 800 residents. There are 37 clusters per arm, and outcomes will be assessed in an average of 32 eligible households per cluster. For randomisation, clusters are stratified by distance to nearest town (< 10 km or ≥ 10 km), and low (< 30%), medium (30–70%), or high (> 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions.DiscussionThis trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts.Trial registrationISRCTN , ISRCTN65922679. Registered on 21 December 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2521-y) contains supplementary material, which is available to authorized users.

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Reducing stunting in India: what investments are needed?

Cited by 16 publications

References 5 publications

Stunting trajectories from post‐infancy to adolescence in Ethiopia, India, Peru, and Vietnam

Stunting trajectories from post‐infancy to adolescence in Ethiopia, India, Peru, and Vietnam

Last and least: Findings on intrahousehold undernutrition from participatory research in South Asia

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