A decomposition analysis of undernutrition inequality among children under-five in India: findings from National Family Health Survey-5

Abstract

Abstract Background Nutrition is crucial for health and human development, especially in early childhood. The nutritional status of children is essential for their development and growth at an early stage of life, with implications extending into adult life. Undernutrition is recognized to be the biggest single threat to public health worldwide, particularly in developing countries. Nutritional status can be determined anthropometrically, which is the outcome of complex interactions between socio-economic and biological variables. This study aimed to measure undernutrition inequality among under-five children in India, and we used a regression-based decomposition analysis to see the impact of socioeconomic determinants on this inequality. Methods The study utilizes data from the National Family Health Survey (NFHS-5) conducted between 2019 and 2021. The concentration indices for stunting, underweight, and wasting examine the magnitude of socio-economic inequality in child undernutrition. Furthermore, a decomposition analysis of the concentration indices is conducted to understand the role of socioeconomic factors in childhood undernutrition inequality. Results The prevalence of child undernutrition was more pronounced among children from lower socio-economic strata. The concentration index for stunting, underweight, and wasting were − 0.126, -0.138, and − 0.064, respectively, indicating a higher burden of undernutrition in lower socio-economic quintiles. Urban children in the lowest socio-economic quintiles experienced greater inequality in these conditions than their rural counterparts. Socio-economic status significantly impacted undernutrition inequality, accounting for approximately 31.26% of stunting inequality, 36.59% of wasting inequality, and 36.61% of underweight inequality. Maternal education was a key contributing factor, explaining 11.77%, 8.78%, and 11.78% of the inequality in stunting, wasting, and underweight, respectively. Maternal factors, particularly maternal education, contributed to undernutrition inequality. More than 80% of the economic inequalities in stunting, underweight, and wasting among children were explained by maternal, socio-economic, and health-seeking factors. Conclusion The average reduction in the national-level undernutrition indices reflects the impact of undernutrition among children in low-income families. To effectively address this issue, the government and policymakers must implement direct and targeted actions to eliminate current inequities in the socio-economic determinants linked with undernutrition. By prioritizing interventions that specifically target vulnerable populations and address the underlying socio-economic factors contributing to undernutrition, policymakers can work towards achieving equitable access to nutrition and improving the health outcomes of all children.