Operations and Decision Sciences Area, Indian Institute of Management Ahmedabad, Ahmedabad, Gujarat, India.
J Nutr Sci. 2024 Sep 26;13:e52. doi: 10.1017/jns.2024.49. eCollection 2024.
India has one of the highest burdens of childhood undernutrition in the world. The two principal dimensions of childhood undernutrition, namely stunting and underweight can be significantly associated in a particular population, a fact that is rarely explored in the extant literature. In this study, we apply a copula geoadditive modelling framework on nationally representative data of 104,021 children obtained from the National Family Health Survey 5 to assess the spatial distribution and critical drivers of the dual burden of childhood stunting and underweight in India while accounting for this correlation. Prevalence of stunting, underweight and their co-occurrence among under 5 children were 35.37%, 28.63% and 19.45% respectively with significant positive association between the two (Pearsonian Chi square = 19346, P-value = 0). Some of the factors which were significantly associated with stunting and underweight were child gender (Adjusted Odds Ratio (AOR) = 1.13 (1.12) for stunting (underweight)), birthweight (AOR = 1.46 (1.64) for stunting (underweight)), type of delivery (AOR = 1.12 (1.19) for stunting (underweight)), prenatal checkup (AOR = 0.94 (0.96) for stunting (underweight)) and maternal short-stature (AOR = 2.19 (1.85) for stunting (underweight)). There was significant spatial heterogeneity in the dual burden of stunting and underweight with highest prevalence being observed in eastern and western states while northern and southern states having relatively lower prevalence. Overall, the results are indicative of the inadequacy of a "one-size-fits-all" strategy and underscore the necessity of an interventional framework that addresses the nutritional deficiency of the most susceptible regions and population subgroups of the country.
印度是全球儿童营养不足负担最重的国家之一。在特定人群中，儿童营养不足的两个主要方面，即发育迟缓与体重不足，可显著相关，这一事实在现有文献中很少被探讨。在这项研究中，我们应用 Copula 地理加性建模框架，对全国代表性的、来自国家家庭健康调查 5 的 104021 名儿童数据进行分析，以评估印度儿童发育迟缓与体重不足双重负担的空间分布及其关键驱动因素，同时考虑到这一相关性。0-5 岁儿童发育迟缓、体重不足和两者同时发生的患病率分别为 35.37%、28.63%和 19.45%，两者之间存在显著的正相关（皮尔逊卡方=19346，P 值=0）。与发育迟缓、体重不足显著相关的因素包括儿童性别（发育迟缓的调整优势比（AOR）=1.13（1.12），体重不足的 AOR=1.12（1.19））、出生体重（发育迟缓的 AOR=1.46（1.64），体重不足的 AOR=1.64（1.85））、分娩方式（发育迟缓的 AOR=1.12（1.19），体重不足的 AOR=1.19（1.12））、产前检查（发育迟缓的 AOR=0.94（0.96），体重不足的 AOR=0.96（0.94））和母亲身材矮小（发育迟缓的 AOR=2.19（1.85），体重不足的 AOR=1.85（2.19））。发育迟缓与体重不足的双重负担存在显著的空间异质性，东部和西部各州的患病率最高，而北部和南部各州的患病率相对较低。总体而言，这些结果表明，“一刀切”的策略是不够的，并强调需要制定一个干预框架，以解决该国最脆弱地区和人口亚群的营养不足问题。
