Understanding the child malnutrition in rural India through the lens of the composite index of anthropometric failure (CIAF): evidence from NFHS-5 (2019-21)

Malnutrition continues to be a significant issue for children under the age of five years in rural areas of India, leading to serious impacts on their health, mental development, and future opportunities. This study sought to thoroughly evaluate concurrent undernutrition by employing a composite index method utilizing data from the National Family Health Survey (2019-2021). A Composite Index of Anthropometric Failure (CIAF) was constructed, encompassing three conventional indices (stunting, wasting, and underweight), to identify key determinants and risk factors associated with malnutrition in rural areas. This study included 177,978 children aged < 60 months (91,881 males and 86,097 females). The results revealed that more than half (59.15%) of the children had at least one form of malnutrition, with stunting being the most prevalent (33.58%). Socio-demographic factors such as caste, religion, wealth quintile, and maternal education were strongly associated with child malnutrition. Children from SC/ST groups, Hindu and Muslim religions, the poorest wealth quintile, and mothers with no education experienced higher rates of anthropometric failure than their counterparts did. Low birth weight, higher birth order, and recent diarrhoeal episodes were also associated with poorer nutritional outcomes. Maternal factors, including younger age at first delivery, lower education level, and BMI, were significant predictors of child malnutrition. These findings highlight the multifaceted nature of malnutrition in rural India and emphasize the need for targeted interventions and evidence-based policies to effectively address this critical public health issue.