Child Undernutrition: Spatial Heterogeneity and Determinants in Low Sociodemographic Index States of India

Background: Childhood malnutrition is a leading cause of under-five mortality, particularly in developing nations, like India.Despite some reductions in underweight and stunting rates among children under five from 2005-2016, progress has been inadequate given India's economic growth.Moreover, one-third of children under five remain stunted and underweight, especially in populous, states such as Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh, which rank low on the socio-demographic index (SDI).Further, identifying target areas can enable more focused resource allocation to meet community needs, which can be done using geospatial mapping and modeling of public health events. Methods:The study utilized data from the national family health survey, covering 82,784 children under five.A spatial analysis was conducted to examine the distribution of malnutrition in the low SDI states of India.Spatial lag models were used to assess the association between malnutrition and its determinants across these regions. Results:The study found that 39.1% of children were stunted, 32.9% were underweight, and 19.3% were wasted.Significant spatial variation in malnutrition was identified across the regions, as indicated by the local Moran index for stunting (I=0.3464;P<0.0001), wasting (I=0.373;P<0.0001), and underweight (I=0.590;P<0.0001).Key factors contributing to regional malnutrition disparities included higher birth order, poor sanitation, non-institutional deliveries, low household wealth, poor maternal body mass index (BMI), and religion. Conclusion:The study highlights significant spatial disparities in child malnutrition across low SDI states in India.Addressing malnutrition in these regions requires targeted public health interventions focusing on poverty alleviation, improving women's education, and enhancing maternal health, particularly in areas with a high prevalence of undernutrition.