Table 1 presents the distribution of children underfive years in India by selected background characteristics, providing descriptive statistics of both the explanatory and outcome variables. The average growth among children, measured through z-scores for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ), was found to be 0.36, 0.31, and 0.19, respectively. Boys slightly outnumbered girls, accounting for 51.80% of the dataset compared to 48.2% for girls. The average age of the children in the dataset was 29.6 months, with ages ranging from 0 to 59 months. Furthermore, a substantial percentage of the children (20.30%) resided in urban areas, while the majority (79.70%) lived in rural areas.
Table 1
Characteristics of a dataset
Background Characteristic | Mean (Standard Deviation) | Number (percentage) | Mini-mum | Maxim-um |
Child health outcome (z-score) | |
Weight for height | 0.19 (0.39) | | 0 | 1 |
Height for age | 0.36 (0.48) | | 0 | 1 |
Weight for age | 0.31 (0.46) | | 0 | 1 |
Sex of children | |
Female | | 112,255(48.2) | | |
Male (reference) | | 120,665(51.8) | | |
Children age ( in months) | 29.6 (17.43) | | 0 | 59 |
Birth order of children | 2.15 (1.35) | | 0 | 16 |
Mother’s education | |
No education (reference) | | 51210(21.99) | | |
Primary | | 4,215(12.91) | | |
Secondary | | 119864(51.5) | | |
Higher | | 31765(13.6) | | |
Mother’s age at birth (in years) | |
15–19(reference) | | 5,461(2.34) | | |
20–24 | | 66,485(28.54) | | |
25–29 | | 92,448(39.69) | | |
30–34 | | 45,587(19.57) | | |
35–39 | | 17,614(7.56) | | |
40–44 | | 4,196(1.82) | | |
45–49 | | 1,129(0.48) | | |
Place of residence | |
Urban(reference) Rural | | 47199(20.3) 85721(79.7) | | |
Wealth quintile | |
Poorest (reference) | | 63,406(27.22) | | |
Poorer | | 54,463(23.38) | | |
Middle | | 45,083(19.36) | | |
Richer | | 39,094(16.78) | | |
Richest | | 30,874(13.26) | | |
Number of Household member | 6.25(2.61) | | 1 | 35 |
The majority of mothers in the dataset have attained secondary education (51.5%), while a notable portion have no formal education (21.99%), with smaller proportions having primary education (12.91%) or higher education (13.6%). Based on the data, the most common age range for mothers at the birth of their children is between 25 and 29 years, representing 39.69% of the dataset, with smaller proportions falling into other age brackets. In terms of wealth distribution, the largest proportion of individuals in the dataset belong to the poorest quintile, comprising 27.22% of the sample, followed by the poorer quintile at 23.38%, with decreasing percentages observed in the middle, richer, and richest quintiles. Additionally, the average family size was 6.25 individuals, and the distribution of children in this study was nearly uniform across economic quintiles.
Table 2
Concentration index and Prevalence rate of under five child malnutrition, NFHS-5
Variable | Stunting | Wasting | Under-weight |
Prevalence (%) | CI | Prevalence (%) | CI | Prevalence (%) | CI |
National | 35.72 | -0.126 | 18.77 | -0.064 | 31.17 | -0.138 |
Urban | 29.89 | -0.148 | 17.64 | -0.053 | 26.08 | -0.159 |
Rural | 37.20 | -0.129 | 19.05 | -0.080 | 15.22 | -0.146 |
Table 2 presents the concentration indices and prevalence rates for stunting, wasting, and underweight among children, disaggregated by national, urban, and rural areas. The prevalence of stunting among Indian children was observed to be higher than that of wasting and underweight. Similarly, this pattern of malnutrition index prevalence was consistent across different residential areas. At the national level, the obtained concentration indices for stunting, wasting, and underweight were − 0.126, -0.064, and − 0.138, respectively. Stunting affects 35.72% of children nationally, with a concentration index of -0.126, indicating a higher concentration among disadvantaged groups. Underweight prevalence is 31.17% nationally, with a similar concentration trend. Wasting, affecting 18.77% of children nationally, exhibits a lower concentration index, suggesting a more equitable distribution across socioeconomic groups. The concentration index values indicated that the lowest quintiles experienced a greater burden of stunting in urban children compared to rural children. Conversely, wasting and underweight concentration indices were somewhat higher in rural areas compared to urban areas. The urban and rural breakdowns revealed differing prevalence rates and concentration indices across the various indicators.
Figure 1 illustrates the prevalence of child’s malnutrition, including stunting, wasting, and underweight, at rural, urban, and national levels in India from 2019 to 2021. The findings indicate that all three indices of child growth were more pronounced among both urban and rural populations. Moreover, while the prevalence of stunting decreased among both urban and rural children during the period, underweight prevalence also declined among these groups. However, wasting increased among both urban and rural children over the same period. These trends were consistent at the national level in India. Additionally, this section presents the findings of the decomposition of socioeconomic inequality and regression analysis in underweight and stunting. Notably, due to the non-significance of the concentration index of wasting, its decomposition results were not included.
Table 3
Stunting (height-for-age) scores: Determinants and decomposition study of the contribution of several explanatory variables, NFHS-5, 2019–21.
Background Characteristic | Elasticity | Coefficient | CIs | Absolute Contribution to CI | Contribution Percentage |
Sex of children | |
Female | -0.0229 | -0.105 | -0.0075 | 0.0002 | -0.0009 |
Birth order of children | 0.1298 | 0.698 | -0.097 | -0.0159 | 0.0629 |
Children age (in months) | 0.1624 | 0.521 | -0.0043 | -0.0007 | -0.0035 |
Mothers education | |
Primary | 0.0589 | 0.069 | 0.2714 | 0.0159 | -0.0799 |
Secondary | -0.0878 | -0.257 | -0.1372 | -0.1206 | 0.0603 |
Higher | 0.2679 | -0.429 | -0.6089 | -0.1631 | 0.8159 |
Mothers' age (in years) at birth |
20–24 | -0.0053 | -0.092 | -0.0929 | 0.0005 | -0.0025 |
25–29 | -0.0339 | -0.248 | 0.0596 | -0.002 | 0.0101 |
30–34 | -0.0302 | -0.389 | 0.0845 | -0.0026 | 0.0128 |
35–39 | -0.0138 | -0.486 | 0.0119 | -0.0002 | 0.0008 |
40–44 | -0.0043 | -0.539 | -0.1039 | 0.0005 | 0.0022 |
45–49 | -0.001 | -0.639 | -0.2808 | 0.0003 | -0.0014 |
Place of residence | |
Rural | -0.0351 | -0.056 | -0.6039 | 0.0212 | -0.1058 |
Wealth-quintile | |
Poorer | -0.0233 | -0.181 | -0.3717 | 0.0087 | -0.0433 |
Middle | -0.0404 | -0.325 | 0.1513 | -0.0061 | 0.0306 |
Richer | -0.0639 | -0.541 | 0.6143 | -0.0393 | 0.1965 |
Richest | -0.0732 | -0.745 | 1 | -0.0732 | 0.3659 |
Constant | | -0.349 | | | |
Table 3 presents coefficients, elasticity’s, concentration indices (CIs), and absolute contributions to CI for several key variables associated with child malnutrition. Female children show a negative association with malnutrition, as indicated by their coefficient of -0.105, elasticity of -0.0229, and CI of -0.0075. A child's age exhibits a positive association, with a coefficient of 0.521, an elasticity of 0.1624, and a CI of -0.0043. The birth order of the child demonstrates a positive association with a coefficient of 0.698 and a CI of -0.0970. Mother's education level shows nuanced effects: primary education has a coefficient of 0.069, secondary education has a coefficient of -0.257, and higher education has a coefficient of -0.429. Mother's age at birth presents mixed effects across different age brackets, with varying coefficients, elasticity’s, and CIs. Rural residence is positively associated with malnutrition, with a coefficient of -0.056, an elasticity of -0.0351, and a CI of -0.6039. Wealth quintiles exhibit a gradient effect, with coefficients ranging from − 0.181 for the poorer quintile to -0.745 for the richest quintile.
Table 4
Wasting (weight-for-age) scores: Determinants and decomposition study of the contribution of several explanatory variables, NFHS-5, 2019–21.
Background Characteristic | Elasticity | Coefficient | CIs | Absolute Contribution to CI | Contribution Percentage |
Sex of children | |
Female | -0. 0402 | -0.112 | -0.0075 | 0. 0003 | -0. 0038 |
Birth order of children | -0. 0078 | -0.209 | -0.097 | 0. 0007 | -0. 0096 |
Children age (months) | -0. 2645 | -0.548 | -0.0043 | 0. 0011 | -0. 0144 |
Mothers education | |
Primary | 0.0467 | -0.109 | 0.2713 | 0.0127 | -0.1595 |
Secondary | 0.0312 | -0.131 | -0.1372 | -0.0043 | 0.0539 |
Higher | 0.1092 | -0.237 | -0.6089 | -0.0665 | 0.8371 |
Mothers' age (in years) at birth |
20–24 | -0.0341 | -0.053 | -0.0929 | 0.0031 | -0.0398 |
25–29 | -0.0237 | -0.022 | 0.0596 | -0.0014 | -0.0178 |
30–34 | -0.0152 | -0.05 | 0.0845 | -0.0013 | -0.0162 |
35–39 | -0.0038 | -0.045 | 0.0119 | -0.0001 | 0.0006 |
40–44 | -0.0012 | -0.076 | -0.1039 | 0.0001 | -0.0015 |
45–49 | 0.0006 | 0.141 | -0.2808 | -0.0002 | 0.0023 |
Place of residence | |
Rural | -0.0691 | 0.098 | -0.6039 | 0.0417 | -0.5251 |
Wealth-quintile | |
Poorer | -0.0255 | -0.151 | -0.3717 | 0.0095 | -0.0119 |
Middle | -0.0393 | -0.214 | 0.1513 | -0.0059 | 0.075 |
Richer | -0.0456 | -0.295 | 0.6143 | -0.0280 | 0.3524 |
Richest | -0.5434 | -0.439 | 1.0000 | -0.0543 | 0.6839 |
Constant | | -0.466 | | | |
Table 4 provides coefficients, elasticity’s, concentration indices (CIs), absolute contributions to CI, and contribution percentages for various variables related to child malnutrition. Female sex shows a coefficient of -0.112, indicating a negative association with malnutrition, with an elasticity of -0.0402 and a CI of -0.0075, contributing − 0.0038 to the overall CI. The child's age exhibits a larger coefficient of -0.548, suggesting a stronger negative association with malnutrition, accompanied by an elasticity of -0.2645 and a CI of -0.0043, contributing − 0.0144. The birth order of the child has a smaller coefficient of -0.209, indicating a less pronounced negative association, with an elasticity of -0.0078 and a CI of -0.0970, contributing − 0.0096. Mother's education level presents varying effects: primary education has a negative coefficient of -0.109, secondary education has a negative coefficient of -0.131, and higher education has a larger negative coefficient of -0.237, each contributing differently to the overall CI. Mother's age at birth displays diverse effects across age groups, with varying coefficients and contributions. Rural residence is associated with a positive CI, while wealth quintiles exhibit gradients, with negative CIs for the poorer quintiles and positive CIs for the richer quintiles.
Table 5
Underweight (weight-for-height) scores: Determinants and decomposition study of the contribution of several explanatory variables, NFHS-5, 2019-21.
Background Characteristic | Elasticity | Coefficient | CIs | Absolute Contribution to CI | Contribution Percentage |
Sex of children | |
Female | -0. 0267 | -0.115 | -0 0074 | -0.0002 | -0.0009 |
Birth order of child | 0.0958 | 0.412 | -0.097 | -0.0093 | 0.0449 |
Children age (in months) | 0. 1376 | 0.607 | -0.0043 | -0.0006 | -0.0029 |
Mothers education | |
Primary | 0.0664 | -0.153 | 0.2714 | 0.0180 | -0.0871 |
Secondary | 0.0765 | -0.289 | -0.1372 | -0.0105 | 0.0508 |
Higher | 0.2452 | -0.497 | -0.6089 | -0.1494 | 0.7222 |
Mothers' age (in years) at birth |
20–24 | -0.0404 | -0.155 | -0.0929 | 0.0038 | -0.0181 |
25–29 | -0.0591 | -0.246 | 0.0596 | -0.0035 | 0.017 |
30–34 | -0.0393 | -0.384 | 0.0845 | -0.0033 | 0.0161 |
35–39 | -0.0166 | -0.495 | 0.0119 | -0.0002 | 0.0009 |
40–44 | -0.0055 | -0.603 | -0.1039 | 0.0006 | -0.0028 |
45–49 | -0.0006 | -490 | -0.2808 | 0.0002 | 0.0002 |
Place of residence | |
Rural | -0.0536 | -0.958 | -0.6039 | 0.0323 | -0.1564 |
Wealth-quintile | |
Poorer | -0.0342 | -0.247 | -0.3717 | 0.0127 | 0.0615 |
Middle | -0.0557 | -0.391 | 0.1513 | -0.0084 | 0.0408 |
Richer | -0.0772 | -0.579 | 0.6143 | -0.0474 | 0.2293 |
Richest | -0.9181 | -0.829 | 1 | -0.9181 | 0.4439 |
Constant | | -0.441 | | | |
Table 5 outlines coefficients, elasticity’s, concentration indices (CIs), absolute contributions to CI, and contribution percentages for various factors affecting child malnutrition. Female sex exhibits a coefficient of -0.115, indicating a negative association with malnutrition, with an elasticity of -0.0267 and a CI of -0.0074, contributing − 0.0009 to the overall CI. Conversely, a child's age presents a coefficient of 0.607, suggesting a positive association, with an elasticity of 0.1376 and a CI of -0.0043, contributing − 0.0029. The birth order of the child demonstrates a positive association with a coefficient of 0.412, an elasticity of 0.0958, and a CI of -0.0970, contributing − 0.0449. Regarding a mother's education level, primary education exhibits a coefficient of -0.153, secondary education has a coefficient of -0.289, and higher education displays a larger coefficient of -0.497, each contributing differently to the overall CI. Mother's age at birth shows varied effects across age groups, with varying coefficients and contributions. Additionally, rural residence is associated with a negative CI, while wealth quintiles display gradients, with negative CIs for poorer quintiles and positive CIs for richer quintiles.
Tables 3, 4, and 5 present the outcomes of decomposition analysis, which include elasticity, coefficient, concentration index, contribution, and absolute contribution percentage of all determinants to socioeconomic inequality in malnutrition. Generally, socioeconomic characteristics more prevalent among lower quintiles (with more negative concentration indices) led to a greater improvement in malnutrition inequality. Moreover, factors associated with higher elasticity were positively related to socioeconomic disparities in malnutrition. However, a significant portion of the socioeconomic disparity in malnutrition among children under the age of five could be determined by socioeconomic level. Approximately 36% of stunting inequalities, 68% of wasting inequality, and 44% of underweight inequality were attributable to socioeconomic status. Maternal education level was another factor contributing to the inequality in stunting, wasting, and underweight (7.99% in stunting, 15.95% in wasting, and 8.71% in underweight). Disparities in residential areas and the average number of child deliveries influenced the remaining inequality in underfive child malnutrition.