International Institute for Population Sciences, Govandi Station Road, Mumbai, Maharashtra, 400088, India.
Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, 29, India.
Sci Rep. 2020 Dec 2;10(1):20991. doi: 10.1038/s41598-020-76884-8.
The public health burden of nutritional deficiency and child mortality is the major challenge India is facing upfront. In this context, using National Family Health Survey, 2015-16 data, this study estimated rate of composite index of anthropometric failure (CIAF) among Indian children by their population characteristics, across states and examined the multilevel contextual determinants. We further investigated district level burden of infant and child mortality in terms of multiple anthropometric failure prevalence across India. The multilevel analysis confirms a significant state, district and PSU level variation in the prevalence of anthropometric failures. Factors like- place of residence, household's economic wellbeing, mother's educational attainment, age, immunization status and drinking water significantly determine the different forms of multiple anthropometric failures. Wealth status of the household and mother's educational status show a clear gradient in terms of the estimated odds ratios. The district level estimation of infant and child mortality demonstrates that districts with higher burden of multiple anthropometric failures show elevated risk of infant and child mortality. Unlike previous studies, this study does not use the conventional indices, instead considered the CIAF to identify the exact and severe form of undernutrition among Indian children and the associated nexus with infant and child mortality at the district level.
营养缺乏和儿童死亡率给公共卫生带来的负担是印度目前面临的主要挑战。在此背景下，本研究利用 2015-16 年国家家庭健康调查数据，根据人口特征，在全国范围内评估了印度儿童复合体格发育失败指数（CIAF）的发生率，并考察了多层面的背景决定因素。我们进一步调查了印度各地区因多种体格发育失败而导致的婴儿和儿童死亡率的负担。多层面分析证实，在体格发育失败的流行程度上，存在显著的邦、地区和 PSUs 层面的差异。一些因素，如居住地点、家庭经济状况、母亲的教育程度、年龄、免疫状况和饮用水，对多种体格发育失败的不同形式有显著影响。家庭的财富状况和母亲的教育状况在估计比值比方面表现出明显的梯度。对婴儿和儿童死亡率的地区估计表明，多重体格发育失败负担较重的地区，婴儿和儿童死亡率的风险更高。与以往的研究不同，本研究没有使用传统的指标，而是采用 CIAF 来确定印度儿童中确切和严重的营养不良形式，以及与婴儿和儿童死亡率在地区层面的关联。
