PMID- 32792002
OWN - NLM
STAT- MEDLINE
DCOM- 20210112
LR  - 20240329
IS  - 1475-9276 (Electronic)
IS  - 1475-9276 (Linking)
VI  - 19
IP  - 1
DP  - 2020 Aug 13
TI  - Assessing inequalities and regional disparities in child nutrition outcomes in 
      India using MANUSH - a more sensitive yardstick.
PG  - 138
LID - 10.1186/s12939-020-01249-6 [doi]
LID - 138
AB  - BACKGROUND: India is strongly committed to reducing the burden of child 
      malnutrition, which has remained a persistent concern. Findings from recent 
      surveys indicate co-existence of child undernutrition, micronutrient deficiency 
      and overweight/obesity, i.e. the triple burden of malnutrition among children 
      below 5 years. While considerable efforts are being made to address this 
      challenge, and several composite indices are being explored to inform policy 
      actions, the methodology used for creating such indices, i.e., linear averaging, 
      has its limitations. Briefly put, it could mask the uneven improvement across 
      different indicators by discounting the 'lagging' indicators, and hence not 
      incentivising a balanced improvement. Signifying negative implications on policy 
      discourse for improved nutrition. To address this gap, we attempt to develop a 
      composite index for estimating the triple burden of malnutrition in India, using 
      a more sensitive measure, MANUSH. METHODOLOGY: Data from publicly available 
      nation-wide surveys - National Family Health Survey (NFHS) and Comprehensive 
      National Nutrition Survey (CNNS), was used for this study. First, we addressed 
      the robustness of MANUSH method of composite indexing over conventional 
      aggregation methods. Second, using MANUSH scores, we assessed the triple burden 
      of malnutrition at the subnational level over different periods NHFS- 3(2005-06), 
      NFHS-4 (2015-16) and CNNS (2106-18). Using mapping and spatial analysis tools, we 
      assessed neighbourhood dependency and formation of clusters, within and across 
      states. RESULT: MANUSH method scores over other aggregation measures that use 
      linear aggregation or geometric mean. It does so by fulfilling additional 
      conditions of Shortfall and Hiatus Sensitivity, implicitly penalising cases where 
      the improvement in worst-off dimension is lesser than the improvement in best-off 
      dimension, or where, even with an overall improvement in the composite index, the 
      gap between different dimensions does not reduce. MANUSH scores helped in 
      revealing the gaps in the improvement of nutrition outcomes among different 
      indicators and, the rising inequalities within and across states and districts in 
      India. Significant clusters (p < 0.05) of high burden and low burden districts 
      were found, revealing geographical heterogeneities and sharp regional 
      disparities. A MANUSH based index is useful in context-specific planning and 
      prioritising different interventions, an approach advocated by the newly launched 
      National Nutrition Mission in India. CONCLUSION: MANUSH based index emphasises 
      balanced development in nutritional outcomes and is hence relevant for diverse 
      and unevenly developing economy like India.
FAU - Jain, Ayushi
AU  - Jain A
AD  - Centre for Technology Alternatives for Rural Areas (CTARA), Indian Institute of 
      Technology, Bombay, Maharashtra, 400076, India.
FAU - Agnihotri, Satish B
AU  - Agnihotri SB
AUID- ORCID: 0000-0002-0703-3185
AD  - Centre for Technology Alternatives for Rural Areas (CTARA), Indian Institute of 
      Technology, Bombay, Maharashtra, 400076, India. sbagnihotri@iitb.ac.in.
LA  - eng
PT  - Journal Article
DEP - 20200813
PL  - England
TA  - Int J Equity Health
JT  - International journal for equity in health
JID - 101147692
RN  - 0 (Micronutrients)
SB  - IM
EIN - Int J Equity Health. 2020 Oct 7;19(1):176. PMID: 33028321
MH  - Child Nutrition Disorders/*epidemiology/prevention & control
MH  - Child, Preschool
MH  - Comorbidity
MH  - Female
MH  - *Health Status Disparities
MH  - *Health Status Indicators
MH  - Humans
MH  - India/epidemiology
MH  - Infant
MH  - Male
MH  - Malnutrition/*epidemiology/prevention & control
MH  - Micronutrients/deficiency
MH  - Nutrition Surveys
MH  - *Nutritional Status
MH  - Obesity/*epidemiology/prevention & control
MH  - Overweight/epidemiology/prevention & control
MH  - Policy
MH  - *Residence Characteristics
MH  - Risk Factors
MH  - Socioeconomic Factors
MH  - Spatial Analysis
PMC - PMC7427294
OTO - NOTNLM
OT  - Balanced development
OT  - Composite index
OT  - Hiatus sensitivity
OT  - India
OT  - Malnutrition
OT  - Policy
OT  - Shortfall sensitivity
OT  - Spatial heterogeneity
OT  - Triple burden
COIS- The authors declare that they have no competing interests.
EDAT- 2020/08/15 06:00
MHDA- 2021/01/13 06:00
PMCR- 2020/08/13
CRDT- 2020/08/15 06:00
PHST- 2020/02/08 00:00 [received]
PHST- 2020/07/30 00:00 [accepted]
PHST- 2020/08/15 06:00 [entrez]
PHST- 2020/08/15 06:00 [pubmed]
PHST- 2021/01/13 06:00 [medline]
PHST- 2020/08/13 00:00 [pmc-release]
AID - 10.1186/s12939-020-01249-6 [pii]
AID - 1249 [pii]
AID - 10.1186/s12939-020-01249-6 [doi]
PST - epublish
SO  - Int J Equity Health. 2020 Aug 13;19(1):138. doi: 10.1186/s12939-020-01249-6.