Co-Occurrences of Forms of Child Undernutrition in India: Insights from the National Family Health Survey

<i>Background</i>: The composite index of anthropometric failure (CIAF) studies co-occurrences of three forms of child undernutrition: stunting (S), wasting (W), and underweight (U). This study attempts to modify it through the inclusion of a fourth form of undernutrition, that is, anaemia (A), serving as a proxy for micronutrient deficiencies among under-five children in India. <i>Methods</i>: Spatial and multivariate analyses were employed to analyse the co-occurrences of child undernutrition with reference to the child's and mother's characteristics using National Family Health Survey (NFHS) data. <i>Results</i>: The modified index of "CIAF + Anaemia" identified thirteen manifestations of child undernutrition in India, the most prevalent co-occurrence being "only anaemia" (30%), followed by a triple burden or co-occurrence of stunting, underweight, and anaemia (SUA) (12%). The prevalence of the quadruple burden of child undernutrition (SWUA) was found to be highest in the states of Jharkhand and Gujarat (7%). A higher likelihood of the co-occurrence of "SUA" was observed among underweight mothers (16%), whereas that of "only anaemia" was observed more among overweight mothers (35%) compared to their counterparts. The co-occurrences "SUA" and "SWUA" were found to be moderately clustered among the districts of India. <i>Conclusions</i>: Overall, the study reinforces the need for early identification and specialised treatment approaches for children burdened with multiple forms of undernutrition to prevent its scarring effect.