Burden of underweight prevalence among under-five children in India: a study on identification of hotspot and region-specific differences

Underweight is a major indicator of undernutrition among under-five children in India, its responsible for children’s chronic and acute diseases. The study aims to identify hotspot and regional differences accompanied with exploring the different socio-economic, demographic, maternal level factors, and child’s individual characteristics responsible for underweight prevalence, The study has extracted a database of 132,656 children aged between 0 and 59 months, from large scale NFHS-5 (2019–2021) dataset, a nationally representative sample. The key outcome in this study was the children’s underweight status (weight-for-age). To highlight the spatial differences, the country was divided into six regions: North, Central, East, North-East, South, and West. Univariate Moran’s I and Getis-Ord Gi statistics were used to understand the clustered underweight districts and hotspots. Apart from descriptive statistics and cross-tabulations and binary logistic regression were used to examine, the association of region specific of underweight. The findings revealed that pronounced regional disparities regarding underweight prevalence, with the Central (28.26%) and Eastern (24.41%) regions recorded the highest burden, while the West (10.78%) and Southern (11.76%) regions of India exhibited comparatively lower prevalence. Getis-Ord value also illustrates the similar result across Central, Eastern and few parts of Western region. Across all regions, low birth weight, mother’s body mass index (BMI) and Wealth index emerged as the strongest predictors of underweight. Children’s anaemia significantly increased the likelihood of underweight in every six regions of India. The results underscore the need for region-specific, child-focused nutrition and health interventions to successfully mitigate the issue of underweight among under-five children in India.