The Timing of Growth Faltering in India Has Changed Significantly over 1992-2016, with Variations in Prenatal and Postnatal Improvement (P10-005-19).

Abstract

Objectives\nIndia accounts for a third of the global population of stunted preschoolers. However, very few studies have documented the timing of growth faltering in India, its evolution over time, or its variation over India s diverse regions. This study develops an approach for estimating the speed of growth faltering and applies it to multiple rounds of national and state-level data.\n\n\nMethods\nNational Family Health Surveys (NHFS) in 1993, 1999, 2006 and 2016, representative both at national and state-level (pooled N\xa0=\xa0328,818), were used to estimate mean height-for-age Z scores (HAZ) for children 0-59 m of age. We plotted HAZ by age curves for each survey period and used spline-based regressions to estimate monthly HAZ loss over the prenatal period (conception to 1 m of age) and three postnatal periods (1-6 m, 6-20 m and 20 m onwards) in each survey round for each state. We used multivariate regressions to compare differences in the determinants of HAZ change between states that saw a predominantly prenatal HAZ improvement and states that saw a predominantly postnatal HAZ improvement.\n\n\nResults\nOver 1993-2006 there was a significant improvement in neonatal HAZ from -0.81 to -0.53 (P\xa0<\xa00.001) at the national level, but no significant improvement in postnatal HAZ loss. However, from 2006 to 2016 most of the increase in HAZ resulted from slower postnatal growth faltering: in the 1-6 m period monthly HAZ loss fell by 50% (P\xa0=\xa00.002) while in the 6-20 m period it declined by 17% (P\xa0<\xa00.001). Across states, however, there were marked differences in HAZ-by-age trends over 2006-16; most states were characterized by significant postnatal growth improvements, but in a few states we observe significant prenatal growth improvements. In the postnatal improvers, changes in household socioeconomic status explained most of the HAZ change. A notable feature of the prenatal improvers is that they saw larger improvements in access to public antenatal care services.\n\n\nConclusions\nPatterns of child growth faltering in India are characterized by both small size at birth (poor maternal nutrition) and rapid postnatal growth faltering (poor feeding and care practices). Despite overall improvements over time, the timing and speed of growth faltering vary markedly by state, with important implications for national and state-level nutrition strategies.\n\n\nFunding Sources\nBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.\n\n\nSupporting Tables Images and/or Graphs