Exploring the paradox of Muslim advantage in undernutrition among under-5 children in India: a decomposition analysis.

BACKGROUND: While there is a substantial body of research on inequalities in child nutrition along the axes of gender and socioeconomic gradient, the socio-religious differences in health and nutrition outcomes remain grossly understudied. The handful of studies on the socio-religious differential in child health outcomes has found a Muslim advantage in chances of survival and nutritional status over Hindus despite their comparatively lower socioeconomic status, which undeniably warrants investigating the pathways through which this paradoxical Muslim advantage manifests. METHODS: Using data from the National Family Health Survey, 2015-16, we quantify the inter-group differentials in child undernutrition (stunting, wasting, and underweight) between Muslims and caste-disaggregated Hindus. We further decompose the gap to delineate its major contributory factors by employing Fairlie's decomposition method. RESULTS: The analysis revealed that, compared to the Hindus as an aggregated group, Muslims have a higher rate of stunting and lower rates of wasting and being underweight. However, the differences get altered when we disaggregate the Hindus into high and low castes. Muslims have a lower prevalence of all three measures of undernutrition than the low-caste Hindus and a higher prevalence of stunting and underweight than the high-caste Hindus, consistent with their levels of socioeconomic status. However, the prevalence of wasting among Muslim children is lower than among high-caste Hindus. This nutritional advantage is paradoxical because Muslims' relatively poorer socioeconomic status compared to high-caste Hindus should have disadvantaged them. In the decomposition analysis, the Muslim advantage over the low-caste Hindus could only be partially attributed to the former's better economic status and access to sanitation. Moreover, the poor performance of Muslim children compared to the high-caste Hindus in stunting and underweight could mainly be explained by the religious differentials in birth order, mother's education, and wealth index. However, Muslim children's comparatively better performance in wasting than the high-caste Hindus remained a puzzle. CONCLUSION: The Muslim advantage over high-caste Hindus in wasting and low-caste Hindus in all the indicators of undernutrition may have been rendered by certain 'unobserved' behavioural and cultural differences. However, further exploration is needed to make a definitive claim in this respect.

Role of seasonality variation in prevalence and trend of childhood wasting in India: An empirical analysis using National Family Health Surveys, 2005-2021.

Background: Wasting develops over a short period and can be reversed with short-term interventions. The prevalence of wasting typically varies from season to season-becoming higher during the monsoon (June to September) season as compared to the winter (October to January) and summer (February to May) seasons every year in a cyclical fashion. However, to the best of our knowledge, using nationally representative demographic surveys to extensively study the impact of the timing of the survey on the results and trends around wasting has not been done so far. Objectives: The goal of this study is to ascertain whether seasonality has an impact on the trend and levels of wasting between NFHS-3 (2005-2006) and NFHS-5 (2019-2021). Methods: The analysis was based on data on 51,555, 259,627, and 232,920 children under 5 years included in NFHS-3, NFHS-4, and NFHS-5 respectively. Multivariable logistic regression analysis and the predicted probabilities approach were employed to examine the effect of the months of interview on the prevalence of wasting. The analysis was conducted for 9 states of India which had data for comparable months to compute wasting levels. Results: We found that at the national level, wasting increased in India by one per cent from NFHS-3 to NFHS-4 but declined by 2% from NFHS-4 to NFHS-5. The results show that seasonality significantly influenced the prevalence of wasting. It was observed that compared to January, the odds of wasting were particularly higher in summer and monsoon seasons, especially in the month of August across all three rounds, indicating the influence of seasonality in the prevalence of wasting in the country. Discussion: The prevalence of wasting in India needs to be interpreted across seasonal changes as seasonality affects many of the variables intrinsically related to child health and nutritional status.

Is mother's financial autonomy associated with stunting among children aged 7-35 months: An empirical study from India.

Stunting depicts chronic deprivation and is a huge public health problem in several developing countries. Considering the sociocultural and sociodemographic factors of India, we aimed to examine the relationship between maternal autonomy and stunting among children <35 months. We have used the data from the latest round of National Family health survey conducted in 2015-16. The main exposure variable was women's autonomy which are represented in our study by the four dimensions- decision-making, physical mobility, financial autonomy, attitudes towards domestic violence, the main predictor variable was stunting among children. Chi-square analysis, univariate and multivariable binary logistic regression analysis were performed to find the association of childhood stunting and women's autonomy. The results were reported at 5% level of significance. All the autonomy variables have shown a significant association with child stunting at 5% level of significance. The unadjusted odds of stunting were found to be significant with respect to all the four dimensions of autonomy variables except physical autonomy. However, after adjusting for other explanatory factors attenuated these relationships and made them statistically insignificant except for women's economic autonomy (AOR = 0.91; 95% C.I.-(0.85, 0.98)) which was found to be significantly affecting the child's status of stunting. Our study reinforces that maternal autonomy is a significant predictor of childhood stunting. Hence, we recommend that policy makers, while designing interventions and policies, must address the socioeconomic inequalities at the community level while devising ways to improve women's empowerment. As it has far-reaching consequences on the nutrition status of the upcoming generations.

Socioeconomic determinants of nutritional status among 'Baiga' tribal children In Balaghat district of Madhya Pradesh: A qualitative study.

The Baigas due to their primitive agricultural techniques, poor education status and poor population growth have been conferred the status of 'Scheduled Tribe' by the Government of India. The community bears the brunt of inequities, reflected in their poor nutritional and socioeconomic status. We have employed qualitative design for the study, as we wanted to understand the contextual factors for Baiga tribal children's inferior nutrition status. Twenty in-depth interviews with the mothers of the children suffering from moderate to severe malnutrition and several other interviews were conducted with the key stakeholders like anganwadi workers, Integrated Child Development Scheme supervisors, Accredited Social Health Activists, public distribution system shopkeeper and registered medical practitioners. Interviews with the key informants were conducted in the Balagahat district of Madhya Pradesh. Key factors responsible for perpetuating malnutrition were then identified through thematic analysis. It was found that dissatisfaction with public services and indifferent attitude of public servants resulting in poor uptake of public services further accentuated the problem. A qualitative enquiry into the issue of high and persistent levels of malnourishment among these tribal children revealed several aspects which quantitative method may not have captured. This implies that while framing a policy for improvement in the nutrition status in such population, a holistic approach is required instead of focussing on one aspect such as supplementation of nutrition alone.