Nutritional status of children in rural and urban India based on National Family Health Surveys

Child health is a crucial indicator of human development, yet India holds two-thirds of the world’s malnourished children, with a rising prevalence. This study examines the prevalence, trends, and determinants of malnutrition components among children aged 0–59 months in rural and urban India using the National Family Health Survey (NFHS)-4 and 5. In the study, malnutrition is assessed using the conventional (stunting, wasting, and underweight) and Composite Index of Anthropometric Failure (CIAF). Binary logistic regression, adjusted for state dummies, was employed to examine the influence of immediate and intermediate factors on child health in rural and urban India. Boxplots reveal a declining trend in all malnutrition indices in both settings. Biplots showed a close relationship between wasting and underweight, with Gujarat having the highest percentage of underweight children, whereas Maharashtra, Jharkhand, Bihar, and Uttar Pradesh had high rates across multiple indicators. In rural areas, adequate diet significantly reduces the odds ratio (OR) of stunting (OR: 0.94, 95% Confidence Interval (CI) 0.92–0.96), underweight (OR: 0.97, 95% CI 0.95-1.00), and CIAF (OR: 0.97, 95% CI 0.94–0.99), whereas diarrhoea increases the likelihood of all malnutrition outcomes. Low birth weight emerges as the strongest risk factor, particularly for underweight (OR: 1.78, 95% CI 1.73–1.84). Antenatal care (ANC) utilisation significantly reduces the odds of stunting (OR: 0.87, 95% CI 0.84–0.89), underweight (OR: 0.91, 95% CI 0.88–0.93), and CIAF (OR: 0.94, 95% CI 0.92–0.97). In urban areas adequate diet significantly reduces the likelihood of CIAF (OR: 0.94, 95% CI 0.90–0.98). Low birth weight, higher birth order, maternal malnutrition, and inadequate ANC emerge as risk factors in urban settings, too. Overall, CIAF confirms that more than half of the under-five children in India are experiencing some form of anthropometric failure, highlighting the importance of residence-specific strategies for targeted nutrition interventions.