Biostatistics, Indian Council of Medical Research-National Institute for Research in Reproductive Health (ICMR-NIRRH), Mumbai, India.
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
J Health Popul Nutr. 2022 Jan 3;41(1):1. doi: 10.1186/s41043-021-00273-8.
Despite significant economic growth and development, undernutrition among children remains a major public health challenge for low- and middle-income countries in the twenty-first century. In Millennium Development Goals, India committed halving the prevalence of underweight children by 2015. This study aimed to explain the geographical variation in child malnutrition level and understand the socio-biomedical predictors of child nutrition in India.
We used the data from India's National Family Health Survey 2015-2016. The survey provided estimates of stunting, wasting, and underweight at the national, state, and district level to measure nutritional status of under-five children. Level of stunting, wasting and underweight at the district level are considered as outcome variables. We have used variance inflation factor to check the multicollinearity between potential predictors of nutrition. In this study, we performed spatial analysis using ArcGIS and multiple linear regression analysis using Stata version 15.
Five states (Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Meghalaya) had very high prevalence of stunting (40% and above). High prevalence of wasting was documented in Jharkhand, Madhya Pradesh, Chhattisgarh, and Karnataka (23 to 29%). Jharkhand, Madhya Pradesh, Maharashtra, and Chhattisgarh had the highest proportion of underweight children in the country. We found that electricity and clean fuel use in the household, use of iodized salt, and level of exclusive breastfeeding had significantly negative influence on the stunting level in the districts. The use of iodized salt has similar effect on the wasting status of under-five children in the districts (b: - 0.27, p < 0.10). Further, underweight level had a negative association with clean fuel use for cooking (b: - 0.17, p < 0.01), use of iodized salt (b: - 0.36, p < 0.10), breastfeeding within one hour (b: - 0.18, p < 0.10), semisolid/solid food within 6-8 months (b: - 0.11, p < 0.05) and Gross Domestic Product of the districts (b: - 0.53, p < 0.10).
In the study, a variety of factors including electricity and clean fuel use in the household, use of iodized salt, level of exclusive breastfeeding, breastfeeding within one hour, semisolid/solid food within 6-8 months and Gross Domestic Product of the districts have a significant association with nutritional status of children.
尽管经济取得了显著增长和发展，但在 21 世纪，营养不足仍是低收入和中等收入国家面临的主要公共卫生挑战。印度在千年发展目标中承诺，到 2015 年将儿童体重不足的比例减半。本研究旨在解释儿童营养不良程度的地域差异，并了解印度儿童营养的社会生物医学预测因素。
我们使用了 2015-2016 年印度国家家庭健康调查的数据。该调查提供了国家、邦和地区层面的发育迟缓、消瘦和体重不足的估计数，以衡量五岁以下儿童的营养状况。地区层面的发育迟缓、消瘦和体重不足程度被视为结果变量。我们使用方差膨胀因子来检查营养潜在预测因素之间的多重共线性。在这项研究中，我们使用 ArcGIS 进行空间分析，并使用 Stata 版本 15 进行多元线性回归分析。
五个邦（北方邦、比哈尔邦、中央邦、恰蒂斯加尔邦和梅加拉亚邦）的发育迟缓率（40%及以上）非常高。贾坎德邦、中央邦、恰蒂斯加尔邦和卡纳塔克邦的消瘦率较高（23%至 29%）。贾坎德邦、中央邦、马哈拉施特拉邦和恰蒂斯加尔邦是该国体重不足儿童比例最高的邦。我们发现，家庭中使用电力和清洁燃料、使用碘盐以及纯母乳喂养的比例对地区的发育迟缓程度有显著的负面影响。碘盐的使用对地区五岁以下儿童的消瘦状况有类似的影响（b：-0.27，p<0.10）。此外，体重不足程度与烹饪用清洁燃料（b：-0.17，p<0.01）、碘盐（b：-0.36，p<0.10）、出生后一小时内母乳喂养（b：-0.18，p<0.10）、6-8 个月内半固体/固体食物（b：-0.11，p<0.05）和地区国内生产总值（b：-0.53，p<0.10）呈负相关。
在这项研究中，包括家庭中使用电力和清洁燃料、使用碘盐、纯母乳喂养、出生后一小时内母乳喂养、6-8 个月内半固体/固体食物以及地区国内生产总值在内的多种因素与儿童的营养状况有显著关联。
