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Region matters: Mapping the contours of undernourishment among children in Odisha, India.
Authors: Apoorva Nambiar, Satish B Agnihotri, Ashish Singh, Dharmalingam Arunachalam
Source: PLOS ONE , Volume 17, issue 6; DOI:
Topic(s): Child feeding
Spatial analysis
Country: Asia
Published: JAN 2022
Abstract: Background: Levels of child undernutrition and its correlates exhibit considerable spatial variation at different levels of granularity. In India, such variations and their interrelation have not been studied at the sub-district level primarily due to the non-availability of good quality granular data. Given the sheer regional diversity in India, it is essential to develop a region-specific evidence base at the micro-level.Data and objectivesThe current study utilised, for the first time, a sub-district level survey data (Concurrent Child Monitoring Survey-II, 2014-15) to investigate the statistically significant clusters and spatial patterns of burden of undernutrition among children. The emergence of distinct patterns at the level of natural geographical regions of the state-coastal, southern and northern regions, lead to a region-specific analysis to measure the impact of various demographic, socio-economic and maternal factors on the prevalence of undernutrition specific to the three regions, using the National Family Health Survey-IV unit-level data. Methods: The spatial dependence and clustering of child undernourishment across sub-districts in Odisha were studied using various spatial statistical techniques, including spatial econometric models. Binary logistic regression was applied in the region-specific analysis. Results: Findings indicated statistically significant spatial clustering of undernutrition among children in specific geographic pockets with poor sanitation, low institutional and skilled deliveries, poor maternal health reinforcing the need for inter-sectoral coordination. Disparities across the three natural-regions, suggest that the parameters requiring priority for intervention may differ across levels of overall development. Conclusion: The spatial clustering of different socio-demographic indicators in specific geographic pockets highlights the differential impact of these determinants on child undernutrition thereby reinforcing a strong need for targeted intervention in these areas. Present analysis and the evidence-based micro-level analysis can be utilised as a model for other Indian states and low-resource countries, making interventions more effective through multiple, synergistic and a multi-sectoral approach.