Childhood Undernutrition Trends in India

Childhood undernutrition is a significant problem in developing countries, including India, and is a major contributor to child mortality worldwide. Although global efforts have prioritized addressing malnutrition through sustainable development goals (SDGs), progress has been uneven. In India, National Family Health Surveys (NFHS) provide crucial data on various health indicators, including childhood nutrition.

A new article presented a secondary analysis of data from four NFHS surveys spanning from 1992-93 to 2015-16, excluding the 2019-20 data. They compared changes in nutritional status among children under 5 years old during the study period – with additional analysis of urban versus rural areas and boys versus girls. 

The results revealed a greater reduction in stunting (16%) compared to underweight (10%) status during this period. Furthermore, the 4th NFHS round showed a higher percentage of malnourished boys (8%) than girls (6%), and higher malnourishment in rural (7%) than urban (5%) children. While consistent improvements in stunting suggest progress in various risk factors, the discrepancy between stunting and underweight reduction raises questions. 

Despite debates about the role of stunting in assessing malnutrition, recent reviews found a strong association between stunting and wasting. It is unlikely that stunting would improve significantly faster than overall undernutrition. One explanation could be that wasting, often caused by acute infections, can lead to stunting when recurring. 

If communities experience fewer acute events causing wasting, it can lead to an overall improvement in stunting. However, cross-sectional surveys may not capture this change in wasting prevalence due to seasonal variations, potentially leading to incorrect conclusions.

The findings do not account for the discrepancy in nutritional trends in India; additionally, potential biases exist. Nevertheless, there has been progress in nutritional indicators, albeit slower than desired. 

Future research directions should involve deeper analyses, including state-wise variations and identifying persistent risk factors, for planning and implementing strategies. Future surveys should also address seasonal biases to provide a clearer picture of India's progress toward achieving SDG-2 goals on time.

Source: Parameswaran N. Indian Journal of Pediatrics. 2023 Aug 18:1-2.