Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys

Objective To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4). Methods National Family Health Survey data from 4 rounds (1992-2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under -2 z score were classified as malnourished by HAZ, WAZ and WHZ. Results A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (-2.1 +/- 1.8 to -1.5 +/- 1.7) but relatively less improved weight for age (-1.8 +/- 1.4 to -1.5 +/- 1.2), the change in wasting status was either nil or meagre (-0.8 +/- 1.4 to -0.9 +/- 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4(th) NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05). Conclusion Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.