Childhood undernutrition inequalities in empowered action group states of India: evidence from NFHS, 2006-2016

Background: Child undernutrition is a major public health problem in many low and middle income countries and malnutrition alone accounted for 45% (3 million deaths annually) deaths among under-five children. Malnutrition is the concealed cause of one out of every two such deaths. A study was undertaken to examine the trends, determinants and socioeconomic-related inequalities in childhood undernutrition in empowered action group (EAG) states, India. The secondary data of the two rounds of National Family Health Survey, NFHS-3 (2005-06) and NFHS-4 (2015-16) comprising of 16,802 and 128,400 children aged 0-59 months respectively was analysed.Methods: Non-linear Fairlie decomposition was used to identify and quantify the separate contribution of different socioeconomic characteristics in gap of childhood malnutrion between 2006 and 2016.Results: Results show that the prevalence of undernutrition has decreased in EAG states during the last one decade, but the prevalence of wasting is remained almost same as 10 years back. The decomposition analysis shows that maternal education, household wealth and place of residence were contributing to socioeconomic inequality in childhood undernutrition from 2006 to 2016.Conclusions: There is a need to adopt different strategies of health policy intervention. It is important to have policies towards improving female literacy in the EAG states because maternal education plays a vital role in child health and literacy rate is very low among women in EAG states. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child undernutrition, so that the vulnerable and deprived populations who are not able to access health care facilities, can easily access health care services for early detection and treatment of undernutrition without any financial constraint.

Intervention to Address Childhood Undernutrition: A Systematic Review

Introduction: Childhood undernutrition while being a preventable condition remains a major public health issue because it contributes to the mortality and morbidity of children globally. Intervention strategies to improve the nutritional status of children include therapeutic food, cash transfers, antibiotics and nutritional education. The objective is to review the effects of various nutritional interventions in addressing undernutrition in children. Methods: Comprehensive search of literature in electronic databases were conducted in PubMed, Science Direct, and Scopus containing the Medical Subject Headings (MeSH) and the title terms ‘Undernutrition’ OR ‘Malnutrition AND ‘Intervention’ OR ‘Management’ AND ‘Children’ OR ‘Childhood’ between January 2000 and August 2019. Of the 4358 studies that were identified, 17 studies matched the inclusion criteria and were reviewed. Results: Therapeutic food is an integral part of nutritional interventions in majority of the studies along with cash transfers and nutritional education. The most consistent outcome in most of the studies was improvement in the nutritional status which subsequently reduces the undernutrition in children. Conclusion: Therapeutic food, conditional cash transfer and nutritional education yielded the best outcome in alleviating undernutrition in developing countries.

Can Nepal achieve nutritional targets by 2030? A trend analysis of childhood undernutrition in Nepal from 2001 to 2016

Objective: This study assesses the prevalence of childhood undernutrition from 2001 to 2016 and estimate projections of undernutrition for 2016–2030 in Nepal. Design: The study used data from four rounds of a cross-sectional survey of Nepal Demographic and Health Survey (NDHS) conducted in 2001, 2006, 2011 and 2016. Descriptive analyses were conducted to calculate prevalence, binary logistic regression was used to test the significance of trends over time and autoregressive integrated moving average model was used to forecast the prevalence of childhood undernutrition. Settings: The children and household member datasets from four NDHS were merged to assess the trends of childhood undernutrition in Nepal. Participants: A total of 16 613 children (8399 male and 8214 female) under 5 years of age were selected for anthropometric measurements using a stratified cluster random sampling method. Results: Overall results show a decline in prevalence of stunting from 57·2 % to 35·8 % (P < 0·001), underweight from 42·7 % to 27 % (P < 0·001) and wasting from 11·2 % to 9·7 % (P < 0·05) from 2001 to 2016. However, different population subgroups have a higher prevalence of undernutrition than national average. Further, the analyses show that the prevalence of stunting will decline to 14·3 % and wasting to 8·4 % by 2030. Conclusion: A remarkable decrease in the prevalence of stunting and underweight has been observed over the last 15 years. Nepal is likely to achieve the nutritional targets for stunting but not for wasting by 2030. Given large subpopulation variations, further improvement in undernutrition require more specific, targeted and localised programmes.