Decades of persistently high rates of childhood malnutrition mean that nearly 40% of the world's stunted living in India – and new strategies are needed to improve the situation, according to a new analysis.
Writing in Social Science & Medicine, researches investigating the relative importance of a variety of factors that influence the risk of childhood malnutrition warned that current prevention strategies must adapt and include a greater focus on social circumstances in addition to nutrition specific goals such as increasing dietary diversity.
“Even though conceptual models on understanding child undernutrition emphasize a multifactorial framework, interventions and factors are often considered in isolation,” noted the research team – led by Daniel Corsi from Ottawa Hospital Research Institute, Canada.
“There appears to be disproportionate focus on what can be termed ‘nutrition-specific’ interventions targeted at addressing the immediate causes of undernutrition, and considerably less emphasis has been placed on more social and structural factors (…) which have been seen to be strongly associated with child nutritional outcomes,” they wrote, adding that the findings from their analysis suggest that improvements in child nutrition may be most effectively achieved strategies focused on a broader progress on social circumstances.
“Factors such as maternal height, BMI, education, and household wealth were highly related to child nutrition, and explained between 60 and 80% of the burden of undernutrition among stunted/underweight children,” the authors said.
Understanding the risk factors
Using data from the 3rd Indian National Family Health Survey (NFHS-3), and “drawing extensively from the UNICEF conceptual framework of determinants of child undernutrition”, the team initially identified a comprehensive set of 15 risk factors for childhood malnutrition.
This included: child's dietary diversity, timing of breast feeding initiation, full vaccination, incidence of infectious disease immediately prior to the survey, access to an improved drinking water source, safe disposal of child stools, access to improved sanitation facilities, use of iodized salt in the household, and an index of household air quality.
Corsi and his colleagues then evaluated the relative importance of these risk factors in the in 27,000 children between 6 and 59 months of age in the NFHS-3 data set, reporting that the five most important predictors of childhood stunting and underweight were short maternal stature, maternal illiteracy, extreme poverty, poor dietary diversity, and maternal underweight.
These five factors had a combined Population Attributable Risks (PAR) of 67.2% and 69.7% for stunting and underweight, respectively, they said – noting that other factors were associated with a combined PAR of 11.7% and 15.1% for stunting and underweight, respectively.
“Among the remaining risk factors dietary diversity appears to be the major factor,” said the team. “Other factors including sanitation, household air quality, and vaccination showed relatively less contribution to explaining variation in child stunting/underweight both in terms of effect size and attributable risk/fraction when conditioning on all risk factors.”
“An important policy implication of our research is to move towards a multi-factorial framework model of addressing child stunting/underweight in India,” they concluded.
Source: Social Science & Medicine
Volume 157, May 2016, Pages 165–185, doi: 10.1016/j.socscimed.2015.11.014
“Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions”
Authors: Daniel J. Corsi, et al