PMID- 35395023 OWN - NLM STAT- MEDLINE DCOM- 20220426 LR - 20220518 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 19 IP - 4 DP - 2022 Apr TI - Association of trends in child undernutrition and implementation of the National Rural Health Mission in India: A nationally representative serial cross-sectional study on data from 1992 to 2015. PG - e1003957 LID - 10.1371/journal.pmed.1003957 [doi] LID - e1003957 AB - BACKGROUND: India launched the National Rural Health Mission (NRHM) in 2005 to strengthen its primary healthcare system in high-focus and northeast-focus states. One of the NRHM objectives was to reduce child undernutrition in India. METHODS AND FINDINGS: We used data from 1992, 1998, 2005, and 2015 National Family Health Survey (NFHS) of India to evaluate trends in child undernutrition prevalence before and after NRHM and across different categories of focus states. Stunting, Wasting, and Comprehensive Index of Anthropometric Failure (CIAF) were assessed using the World Health Organization (WHO) growth curves to assess chronic, acute, and overall undernutrition. The study included 187,452 children aged 3 years or under. Survey-weighted and confounder-adjusted average annualized reduction rates (AARRs) and predicted probability ratios were used to assess trends and socioeconomic disparities for child undernutrition, respectively. Nationwide, the prevalence of all types of undernutrition decreased from 1992 to 2015. However, the trends varied before and after NRHM implementation and differentially by focus states. After NRHM, acute undernutrition declined more rapidly among high-focus states (AARR 1.0%) but increased in normal-focus states (AARR -1.9% per year; p-value for the difference <0.001). In contrast, the prevalence of chronic undernutrition declined more rapidly (AARR 1.6%) in the normal-focus states in comparison to high-focus states (0.3%; p-value for the difference = 0.01). Income and caste-based disparities in acute undernutrition decreased but did not disappear after the implementation of the NRHM. However, similar disparities in prevalence of chronic undernutrition appear to be exacerbated after the implementation of the NRHM. Major limitations of this study include the observational and cross-sectional design, which preclude our ability to draw causal inferences. CONCLUSIONS: Our results suggests that NRHM implementation might be associated with improvement in wasting (acute) rather than stunting (chronic) forms of undernutrition. Strategies to combat undernutrition equitably, especially in high-focus states, are needed. FAU - Soni, Apurv AU - Soni A AUID- ORCID: 0000-0001-5049-3657 AD - Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, United States of America. AD - Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, United States of America. FAU - Fahey, Nisha AU - Fahey N AUID- ORCID: 0000-0001-9059-1470 AD - Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, United States of America. AD - Department of Pediatrics, UMass Chan Medical School, Worcester, Massachusetts, United States of America. FAU - Bhutta, Zulfiqar AU - Bhutta Z AUID- ORCID: 0000-0003-0637-599X AD - Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. AD - Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada. FAU - Li, Wenjun AU - Li W AD - Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, United States of America. FAU - Moore Simas, Tiffany AU - Moore Simas T AUID- ORCID: 0000-0002-8356-6418 AD - Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, United States of America. AD - Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, Massachusetts, United States of America. FAU - Nimbalkar, Somashekhar AU - Nimbalkar S AUID- ORCID: 0000-0003-2825-2819 AD - Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India. FAU - Allison, Jeroan AU - Allison J AUID- ORCID: 0000-0003-4472-2112 AD - Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, United States of America. LA - eng GR - F30 HD091975/HD/NICHD NIH HHS/United States GR - T32 GM107000/GM/NIGMS NIH HHS/United States GR - TL1 TR001454/TR/NCATS NIH HHS/United States GR - P60 MD006912/MD/NIMHD NIH HHS/United States GR - U01DP006093/ACL/ACL HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural DEP - 20220408 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Child MH - *Child Nutrition Disorders/epidemiology MH - Cross-Sectional Studies MH - Growth Disorders/epidemiology MH - Humans MH - India/epidemiology MH - Infant MH - *Malnutrition/epidemiology MH - Prevalence MH - Rural Health PMC - PMC9032440 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: One of the authors (ZAB) is on the editorial board of PLOS Medicine and was a Guest Editor for the Global Child and Adolescent Health Special Issue. EDAT- 2022/04/09 06:00 MHDA- 2022/04/27 06:00 PMCR- 2022/04/08 CRDT- 2022/04/08 17:10 PHST- 2021/02/14 00:00 [received] PHST- 2022/03/07 00:00 [accepted] PHST- 2022/04/22 00:00 [revised] PHST- 2022/04/09 06:00 [pubmed] PHST- 2022/04/27 06:00 [medline] PHST- 2022/04/08 17:10 [entrez] PHST- 2022/04/08 00:00 [pmc-release] AID - PMEDICINE-D-21-00795 [pii] AID - 10.1371/journal.pmed.1003957 [doi] PST - epublish SO - PLoS Med. 2022 Apr 8;19(4):e1003957. doi: 10.1371/journal.pmed.1003957. eCollection 2022 Apr.