Nutrition, St John's Research Institute, Bengaluru, Karnataka, India.
Division of Biostatistics, St John's Research Institute, Bangalore, Karnataka, India.
BMJ Open. 2022 Apr 5;12(4):e055098. doi: 10.1136/bmjopen-2021-055098.
Approximately one-third of the world's stunted (low height-for-age) preschool-aged children live in India. The success of interventions designed to tackle stunting appears to vary by location and depth of poverty. We developed small-area estimation models to assess the potential impact of increments in household income on stunting across the country.
Two nationally representative cross-sectional datasets were used: India's National Family Health Survey 4 (2015-2016) and the 68th round of the National Sample Survey on consumer expenditure. The two datasets were combined with statistical matching. Gaussian process regressions were used to perform geospatial modelling of 'stunting' controlling for household wealth and other covariates.
The number of children in this sample totalled 259 627. Children with implausible height-for-age z-scores (HAZs) >5 or <-5, or missing data on drinking water, sanitation facility, mother's education, or geolocation and children not residing in mainland India were excluded, resulting in 207 695 observations for analysis.
A monthly transfer of ~$7 (500 Indian rupees) per capita to every household (not targeted or conditional) was estimated to reduce stunting nationally by 3.8 percentage points on average (95% credible interval: 0.14%-10%), but with substantial variation by state. Estimated reduction in stunting varied by wealth of households, with the poorest quintile being likely to benefit the most.
Improving household income, which can be supported through cash transfers, has the potential to significantly reduce stunting in parts of India where the burdens of both stunting and poverty are high. Modelling shows that for other regions, income transfers may raise incomes and contribute to improved nutrition, but there would be a need for complementary activities for alleviating stunting. While having value for the country as a whole, impact of income gained could be variable, and underlying drivers of stunting need to be tackled through supplementary interventions.
全世界大约有三分之一发育迟缓（身高年龄偏低）的学龄前儿童生活在印度。解决发育迟缓问题的干预措施的效果似乎因地点和贫困程度的不同而有所差异。我们开发了小区域估计模型，以评估家庭收入增加对全国范围内发育迟缓的潜在影响。
使用了两项具有全国代表性的横断面数据集：印度国家家庭健康调查 4 期（2015-2016 年）和第 68 轮全国消费者支出抽样调查。这两个数据集通过统计匹配进行了合并。使用高斯过程回归对“发育迟缓”进行了地理空间建模，控制了家庭财富和其他协变量。
本样本中的儿童总数为 259627 名。身高年龄 Z 分数（HAZ）>5 或<-5 的儿童或身高年龄 Z 分数数据不可信、饮用水、卫生设施、母亲教育、地理位置缺失的数据以及未居住在印度大陆的儿童被排除在外，最终分析了 207695 个观测值。
估计全国范围内，每月向每个家庭（非定向或有条件）人均转移约 7 美元（500 印度卢比），平均可使发育迟缓率降低 3.8 个百分点（95%可信区间：0.14%-10%），但各州之间存在较大差异。估计的发育迟缓减少量因家庭财富而异，最贫困的五分位数可能受益最大。
提高家庭收入（可以通过现金转移来支持）有可能显著降低印度部分地区的发育迟缓率，这些地区的发育迟缓负担和贫困负担都很高。建模表明，对于其他地区，收入转移可能会提高收入并有助于改善营养，但需要采取补充活动来缓解发育迟缓。虽然对整个国家具有价值，但收入增加的影响可能存在差异，需要通过补充干预措施来解决发育迟缓的根本驱动因素。
