The United Nations Children's Fund (UNCF) has described malnutrition as the "silent emergency" since it causes undernutrition, which includes underweight, stunting, and wasting [1, 2, 3]. Malnutrition are classified in to undernutrition (stunting, wasting and underweight) and over nutrition (overweight and obesity) condition of human being while childhood morbidities are the outcome of undernutrition among the under-5 children [4]. Malnutrition among the under-five children’s is the major underlying cause of child morbidity and child mortality in many developing countries like India [5]. Malnutrition in under-five aged children increase the risk of infections, child morbidity and mortality and also reduce the mental development and nutritional status which is the best global indicator of wellbeing in children [6, 7, 8].
In India, undernutrition in children under the age of five is a serious public health issue [9] and the prevalence of it is highest in the globe and roughly twice as common in Sub-Saharan Africa [10, 11]. Almost 60 million children in India are underweight [12]. It has both long and short term irreversible negative health outcomes [13]. The short-term consequences of undernutrition are morbidity, mortality, and disability [14] and long term consequences of undernutrition largely affected brain structure and function along with reduced mental ability and learning capacity, poor school performance, and lower earnings [15]. Young children's physical and cognitive development is adversely affected by long-term undernutrition [16]. Nutritional status of children can be assessed in term of physical, biological, mental characteristics and stunting, wasting, underweight is the important indicator of undernutrition that affects the development and improvement of under-five children’s which indirectly influence the economy of the country [17, 18].This is not a simple problem with single solution, it is the result of multiple and hierarchical interrelated determinant [19].
The causes of childhood malnutrition are multiple phenomenons. It is mainly affected by several socio-economic (religion, caste, education, wealth, family income), demographic (age of mother, age at marriage), proximal (gestation age, birth interval, maternal BMI, birth interval) and environmental determinants [20–24]. Many of the previous studies identified that there are many factors effect on child growth failure, these are poor household, food insecurity, residence in rural areas, maternal depression and deficiency of infant feeding [25–32]. As per UNICEF report (2006), the main factor behind childhood malnutrition are insufficient diet, frequent infections, poor breastfeeding practices, delayed introduction of complementary foods and inadequate protein in the diet, health status, food taboos, growth and personal choice related to diet [33].
The UNICEF/WHO/WB Joint Child Malnutrition Estimates (JME) Group released new data for 2021 showing that in 2020, globally, 149.2 million children under the age of 5 were stunted, 45.4 million wasted and 38.9 million overweight [34]. According to World Health Statistics Report (WHSR, 2012), India ranked second worldwide for child malnutrition (43.1%) after Timor-Leste (43.7%) which is a significant barrier to succeed better health outcome of the children [35]. According to National Family Health Survey (NFHS 5), prevalence of undernutrition among under five children in India shows that 32.1% under five children were underweight, 35.5% were stunted and 19.3% were wasted and there also exits a huge difference of undernutrition between rural and urban areas. The prevalence of undernutrition has not decreased as intended from the National Family Health Survey 1 to the National Family Health Survey 5.
Ministry of health and family welfare, Government of India established 8 Empowered Action Group (EAG) states in 2001 for achieving national health goals by monitoring and facilitating the Millennium Development Goal, these are Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and Uttarakhand [36]. The states are socio-economically backward in term of demographic and epidemiological transition, characterized by high population growth rate, high infant and child morality, high fertility [37–39]. The EAG states are highly populous and constitute 45.9% share of India’s population. It is notable that half of the population below the poverty line in India is lived in the EAG states. The latest round (NFHS-5, 2019-21) reported that 35.3% children aged under-5 years of EAG states were stunted that is too short for their age; 18.6% children were wasted and 31.9% children were underweight i.e. too thin to their age.
The achievement of 2030 Sustainable Development Goals (SDGs) as well national health goals is very essential in contemporary time for the development of a nation like India. The undernutrition scenario and nutrition related factors that enhance Sustainable Development Goals (SDGs) in India as well as EAGs are not in good conditions [40]. The nation won't achieve its SDGs of reducing child mortality if undernutrition is not successfully addressed [41]. Even though India's economy is expanding, both urban and rural areas still have significant rates of undernutrition-related child mortality [42].
Most of previous studies on malnutrition as well as undernutrition were carried out in rural and urban areas of India that basically focus on prevalence and determinants of undernutrition. A very few number of study of under five children have been conducted at community level and or district level in EAGs states (Table 1). Still no such study was conducted to analyse the current prevalence and change detection of undernutrition of under five children in the EAGs states in India in a comparative way. To bridge this gap, the current study was conducted to assess the changes of the indicator of undernutrition with the help of anthropometric measurement of under five children in the EAG states and represent the current (NFHS-5, 2019-21) prevalence of child undernutrition indices (stunting, wasting and underweight) among the EAG states of India. The study is helpful for policy making and creates public awareness about the child malnutrition in the EAG states by understanding the prevalence and changing pattern of malnutrition among the most focused states of India.