SpringerLink
Log in

A Multilevel Analysis of Factors Associated with Malnutrition among Tribal Children in India: Evidence from National Family Health Survey 2015-16

  • Published:
Child Indicators Research Aims and scope Submit manuscript

Abstract

Health and the related problems are very much interlinked with the socio-economic conditions of the community, particularly the tribes who are living in the remote and inaccessible areas where health care and development services of the government are not available. This study aims to examine child malnutrition among tribal children in India. The study uses data from the fourth round of National Family Health Survey. Bivariate and multilevel analyses have been used to fulfil the objectives of the study. Results reveal that overall prevalence of stunting, wasting and underweight among tribal children under three years of age was 41%, 30% and 43% respectively. Child age, sex, size at birth, age of the women at first birth and their education, duration of breastfeeding, religion, and wealth index are significantly associated with malnutrition among tribal children. The chances of stunting are more among tribal families with two or more children. On the other hand, the likelihood of underweight is more likely among tribal children who are suffering from diarrhoea and fever. Community variables like the place of residence, community education, and community wealth have a significant positive effect on stunting, wasting, and underweight, respectively. Therefore, the study recommended implementation of policies specific to the tribal population through improving individual as well as community-level education to ensure the reduction in malnourishment among tribal children in India. Moreover services provided by the government should be made accessible to this vulnerable group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

No ethical approval needed for this data.

References

  • Adekanmbi, V. T., Kayode, G. A., & Uthman, O. A. (2013). Individual and contextual factors associated with childhood stunting in Nigeria: A multilevel analysis. Maternal & Child Nutrition, 9(2), 244–259.

    Article  Google Scholar 

  • Adhikari, T., Yadav, J., Tripathi, N., Tolani, H., Kaur, H., & Rao, M. V. V. (2020). Do tribal children experience elevated risk of poor nutritional status in India? A multilevel analysis. Journal of Biosocial Science, 1–26.

  • Alderman, H., Hoddinott, J., & Kinsey, B. (2006). Long term consequences of early childhood malnutrition. Oxford Economic Papers, 58(3), 450–474.

    Article  Google Scholar 

  • Ambadekar, N. N., & Zodpey, S. P. (2017). Risk factors for severe acute malnutrition in under-five children: A case-control study in a rural part of India. Public Health, 142, 136–143.

    Article  Google Scholar 

  • Arunkumar, N., & Hidhayathulla, A. (2015). Measuring poverty through child malnutrition, a study with special reference to Arumbavur village at Perambalur district. Journal of Economics and Finance, 6(2), 10–13.

  • Barker, D. J., & Osmond, C. (1986). Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. The Lancet, 327(8489), 1077–1081.

    Article  Google Scholar 

  • Bawdekar, M., & Ladusingh, L. (2008). Contextual correlates of child malnutrition in rural Maharashtra. Journal of Biosocial Science, 40(5), 771–786.

    Article  Google Scholar 

  • Benson, T., & Shekar, M. (2006). Trends and issues in child undernutrition. In Disease and mortality in sub-Saharan Africa (2nd ed.). https://doi.org/10.1596/978-0-8213-6397-3.

  • Bepari, M., Pal, A., Maity, P., & Maiti Choudhury, S. (2015). Nutritional and health status of adult women of the Lodha tribal population of Paschim Midnapore, West Bengal, India: Compared with non-tribal women. East African Journal of Public Health, 12(1), 988e96.

    Google Scholar 

  • Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M., Mathers, C., & Rivera, J. (2008). Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet, 371(9608), 243–260. https://doi.org/10.1016/S0140-6736(07)61690-0.

    Article  Google Scholar 

  • Case, A., Lubotsky, D., & Paxson, C. (2002). Economic status and health in childhood: The origins of the gradient. American Economic Review, 92(5), 1308–1334.

    Article  Google Scholar 

  • Chakrabarty, S., Ghosh, R., & Bharati, P. (2007). Breastfeeding practices and nutritional status of preschool children among the Shabar tribal community in Orissa, India.

  • Chatterjee, K., Sinha, R. K., Kundu, A. K., Shankar, D., Gope, R., Nair, N., & Tripathy, P. K. (2016). Social determinants of inequities in under-nutrition (weight-for-age) among under-5 children: A cross sectional study in Gumla district of Jharkhand, India. International Journal for Equity in Health, 15(1), 104. https://doi.org/10.1186/s12939-016-0392-y.

    Article  Google Scholar 

  • Chowdhury, T. R., Chakrabarty, S., Rakib, M., Saltmarsh, S., & Davis, K. A. (2018). Socio-economic risk factors for early childhood underweight in Bangladesh. Globalization and Health, 14(1), 54.

    Article  Google Scholar 

  • Das, S., & Bose, K. (2012). Nutritional deprivation among Indian tribals: A cause for concern. Anthropological Notebooks, 12.

  • Dasgupta, A., Sahoo, S. K., Taraphdar, P., Preeti, P. S., Biswas, D., Kumar, A., & Sarkar, I. (2015). Composite index of anthropometric failure and its important correlates: A study among under-5 children in a slum of Kolkata, West Bengal, India. International Journal of Medical Science and Public Health, 4(3), 414–420.

    Article  Google Scholar 

  • Debnath, A., & Bhattacharjee, N. (2014). Factors associated with malnutrition among tribal children in India: A non-parametric approach. Journal of tropical pediatrics, 60(3), 211–215.

    Article  Google Scholar 

  • Devara, R., & Deshmukh, D. (2017). Impact of nutritious meals on the nutritional status of the tribal students: A comparison between centralized kitchens (annapurna) and regular kitchens in government tribal residential schools from two districts of Maharashtra, India. Indian Journal of Public Health, 61(4), 233–238.

    Article  Google Scholar 

  • Dey, I., & Chaudhuri, R. N. (2008). Gender inequality in nutritional status among under five children in a village in Hooghly district, West Bengal. Indian Journal of Public Health, 52(4), 218–220.

    Google Scholar 

  • Dey, U., & Bisai, S. (2019). The prevalence of under-nutrition among the tribal children in India: A systematic review. Anthropological Review, 82(2), 203–217. https://doi.org/10.2478/anre-2019-0015.

    Article  Google Scholar 

  • Dhami, M. V., Ogbo, F. A., Osuagwu, U. L., Ugboma, Z., & Agho, K. E. (2019). Stunting and severe stunting among infants in India: The role of delayed introduction of complementary foods and community and household factors. Global Health Action, 12(1), 1638020.

    Article  Google Scholar 

  • Fall, C. H. D. (2013). Fetal malnutrition and long-term outcomes. In J. Bhatia, Z. A. Bhutta, & S. C. Kalhan (Eds.), Nestlé nutrition institute workshop series (Vol. 74, pp. 11–25). S. KARGER AG. https://doi.org/10.1159/000348384.

    Chapter  Google Scholar 

  • IIPS and ICF. (2017). National family health survey (NFHS-4), 2015–16. Mumbai: IIPS.

    Google Scholar 

  • India State-Level Disease Burden Initiative Malnutrition Collaborators. (2019). The burden of child and maternal malnutrition and trends in its indicators in the states of India: The global burden of disease study 1990–2017. The Lancet Child and Adolescent Health, 3, 855–870.

    Article  Google Scholar 

  • Islam, S., Mahanta, T. G., Sarma, R., & Hiranya, S. (2014). Nutritional status of under 5 children belonging to tribal population living in riverine (char) areas of Dibrugarh district, Assam. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 39(3), 169–174.

    Article  Google Scholar 

  • Issaka, A. I., Agho, K. E., Burns, P., Page, A., & Dibley, M. J. (2015). Determinants of inadequate complementary feeding practices among children aged 6–23 months in Ghana. Public Health Nutrition, 18, 669–678.

    Article  Google Scholar 

  • Kapoor, A. K., & Dhall, M. (2016). Poverty, Malnutrition and Biological Dynamics among Tribes of India. Health Science Journal, 5.

  • Kar, B. R., Rao, S. L., & Chandramouli, B. A. (2008). Cognitive development in children with chronic protein energy malnutrition. Behavioral and Brain Functions, 4(1), 31.

    Article  Google Scholar 

  • Keino, S., Plasqui, G., Ettyang, G., & van den Borne, B. (2014). Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. Food and Nutrition Bulletin, 35, 167–178.

    Article  Google Scholar 

  • Khan, S., Zaheer, S., & Safdar, N. F. (2019). Determinants of stunting, underweight and wasting among children < 5 years of age: Evidence from 2012-2013 Pakistan demographic and health survey. BMC Public Health, 19(1), 358. https://doi.org/10.1186/s12889-019-6688-2.

    Article  Google Scholar 

  • Khandare, A. L., Siruguri, V., Rao, A., Venkaiah, K., Reddy, G., & Rao, G. S. (2008). Diet and nutrition status of children in four tribal blocks of thane district of Maharashtra, India (nutrition status of children). Pakistan Journal of Nutrition, 7, 485–488.

    Article  Google Scholar 

  • Kshatriya, G. K., & Ghosh, A. (2008). Undernutrition among the tribal children in India: Tribes of coastal, Himalayan and Desert ecology. Anthropologischer Anzeiger, 66, 355–363.

    Article  Google Scholar 

  • Kumar, D., Goel, N. K., Mittal, P. C., & Misra, P. (2006). Influence of infant-feeding practices on nutritional status of under-five children. The Indian Journal of Pediatrics, 73(5), 417–421.

    Article  Google Scholar 

  • Kumar, R., Abbas, F., Mahmood, T., & Somrongthong, R. (2019). Prevalence and factors associated with underweight children: A population-based subnational analysis from Pakistan. BMJ Open, 9(7), e028972.

    Article  Google Scholar 

  • Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., Cousens, S., Mathers, C., & Black, R. E. (2015). Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: An updated systematic analysis. The Lancet, 385(9966), 430–440. https://doi.org/10.1016/S0140-6736(14)61698-6.

    Article  Google Scholar 

  • Mamabolo, R. L., Alberts, M., Mbenyane, G. X., Steyn, N. P., Nthangeni, N. G., Delemarre-van de Waal, H. A., & Levitt, N. S. (2004). Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa. Nutrition., 20, 327–333.

    Article  Google Scholar 

  • Manjunath, R. (2014). Malnutrition among under-five children of Kadukuruba Tribe: Need to Reach the Unreached. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/JCDR/2014/9436.4548.

  • Martins, V. J. B., Toledo Florêncio, T. M. M., Grillo, L. P., do Carmo Franco, M. P., Martins, P. A., Clemente, A. P. G., Santos, C. D. L., de Vieira, M. F. A., & Sawaya, A. L. (2011). Long-lasting effects of Undernutrition. International Journal of Environmental Research and Public Health, 8(6), 1817–1846. https://doi.org/10.3390/ijerph8061817.

    Article  Google Scholar 

  • Martorell, R. (1999). The nature of child malnutrition and its long-term implications. Food and Nutrition Bulletin, 20(3), 288–292.

    Article  Google Scholar 

  • Meshram, I. I., Arlappa, N., Balakrishna, N., Laxmaiah, A., Mallikarjun Rao, K., Gal Reddy, C., et al. (2012). Prevalence and determinants of undernutrition and its trends among pre-school tribal children of Maharashtra state, India. Journal of Tropical Pediatrics, 58(2), 125–132.

    Article  Google Scholar 

  • Mitra, M., Kumar, P. V., Chakrabarty, S., & Bharati, P. (2007). Nutritional status of Kamar tribal children in Chhattisgarh. The Indian Journal of Pediatrics, 74(4), 381–384.

    Article  Google Scholar 

  • Mwanri, L., Worsley, A., Ryan, P., & Masika, J. (2000). Supplemental vitamin A improves Anemia and growth in anemic school children in Tanzania. The Journal of Nutrition, 130(11), 2691–2696. https://doi.org/10.1093/jn/130.11.2691.

    Article  Google Scholar 

  • Myatt, M., Khara, T., Schoenbuchner, S., Pietzsch, S., Dolan, C., Lelijveld, N., & Briend, A. (2018). Children who are both wasted and stunted are also underweight and have a high risk of death: A descriptive epidemiology of multiple anthropometric deficits using data from 51 countries. Archives of Public Health, 76(1), 28. https://doi.org/10.1186/s13690-018-0277-1.

    Article  Google Scholar 

  • Narain, J. (2019). Health of tribal populations in India: How long can we afford to neglect? Indian Journal of Medical Research, 149(3), 313–316. https://doi.org/10.4103/ijmr.IJMR_2079_18.

    Article  Google Scholar 

  • Pathak, P. K., & Singh, A. (2011). Trends in malnutrition among children in India: Growing inequalities across different economic groups. Social Science & Medicine, 73(4), 576–585.

    Article  Google Scholar 

  • Penda, C. I., Eboumbou Moukoko, E. C., Nolla, N. P., Evindi Abomo, O. N., & Koki Ndombo, P. (2018). Malnutrition among HIV infected children under 5 years of age at the Laquintinie hospital Douala, Cameroon, Pan African Medical Journal., 30. https://doi.org/10.11604/pamj.2018.30.91.15832.

  • Pillai, V. K., & Maleku, A. (2019). Women's education and child stunting reduction in India. Journal Society and Society Welfare, 46, 111.

    Google Scholar 

  • Rajpal, S., Kim, R., Sankar, R., Kumar, A., Joe, W., & Subramanian, S. V. (2020). Frequently asked questions on child anthropometric failures in India. Economic & Political Weekly, 55(6).

  • Savanur, M. S., & Ghugre, P. S. (2015). Magnitude of undernutrition in children aged 2 to 4 years using CIAF and conventional indices in the slums of Mumbai city. Journal of Health, Population and Nutrition, 33(1), 3. https://doi.org/10.1186/s41043-015-0017-x.

    Article  Google Scholar 

  • Seetharaman, N., Chacko, T., Shankar, S., & Mathew, A. (2007). Measuring malnutrition -the role of Z scores and the composite index of anthropometric failure (CIAF). Indian Journal of Community Medicine, 32(1), 35. https://doi.org/10.4103/0970-0218.53392.

    Article  Google Scholar 

  • Sethuraman, K., Lansdown, R., & Sullivan, K. (2006). Women’s empowerment and domestic violence: The role of sociocultural determinants in maternal and child Undernutrition in tribal and rural communities in South India. Food and Nutrition Bulletin, 27(2), 128–143. https://doi.org/10.1177/156482650602700204.

    Article  Google Scholar 

  • Sethy, S. G., Jena, D., Jena, P., Pradhan, S., & Biswas, T. (2017). Prevalence of malnutrition among under five children of urban slums of Berhampur, Odisha, India: A community a community based cross-sectional study. International Journal of Contemporary Pediatrics, 4(6), 2180–2186. https://doi.org/10.18203/2349-3291.ijcp20174753.

    Article  Google Scholar 

  • Singh, D. K., Alagarajan, M., & Ladusingh, L. (2015). What explains child malnutrition of indigenous people of Northeast India? PLoS One, 10(6), e0130567.

  • Singh, S., Srivastava, S., & Upadhyay, A. K. (2019). Socio-economic inequality in malnutrition among children in India: An analysis of 640 districts from National Family Health Survey (2015–16). International Journal for Equity in Health, 18(1), 203. https://doi.org/10.1186/s12939-019-1093-0.

    Article  Google Scholar 

  • Subramanyam, M. A., Kawachi, I., Berkman, L. F., & Subramanian, S. V. (2010). Socioeconomic inequalities in childhood undernutrition in India: Analyzing trends between 1992 and 2005. PLoS One, 5(6), e11392.

    Article  Google Scholar 

  • Swaminathan, S., Hemalatha, R., Pandey, A., Kassebaum, N. J., Laxmaiah, A., Longvah, T., Lodha, R., Ramji, S., Kumar, G. A., Afshin, A., Gupta, S. S., Kar, A., Khera, A. K., Mathai, M., Awasthi, S., Rasaily, R., Varghese, C. M., Millear, A. I., Manguerra, H., Gardner, W. M., Sorenson, R., Sankar, M. J., Purwar, M., Furtado, M., Bansal, P. G., Barber, R., Chakma, J. K., Chalek, J., Dwivedi, S., Fullman, N., Ginnela, B. N., Glenn, S. D., Godwin, W., Gonmei, Z., Gupta, R., Jerath, S. G., Kant, R., Krish, V., Kumar, R. H., Ladusingh, L., Meshram, I. I., Mutreja, P., Nagalla, B., Nimmathota, A., Odell, C. M., Olsen, H. E., Pati, A., Pickering, B., Radhakrishna, K. V., Raina, N., Rankin, Z., Saraf, D., Sharma, R. S., Sinha, A., Varanasi, B., Shekhar, C., Bekedam, H. J., Reddy, K. S., Lim, S. S., Hay, S. I., Dandona, R., Murray, C. J. L., Toteja, G. S., & Dandona, L. (2019). The burden of child and maternal malnutrition and trends in its indicators in the states of India: The global burden of disease study 1990–2017. The Lancet Child & Adolescent Health, 3(12), 855–870. https://doi.org/10.1016/S2352-4642(19)30273-1.

    Article  Google Scholar 

  • Tette, E. M. A., Sifah, E. K., & Nartey, E. T. (2015). Factors affecting malnutrition in children and the uptake of interventions to prevent the condition. BMC Pediatrics, 15(1), 189. https://doi.org/10.1186/s12887-015-0496-3.

    Article  Google Scholar 

  • UNICEF. (2014). Nourishing India's tribal children: The nutrition situation of children of India's scheduled tribes. New Delhi. Available at: http://unicef. in/Uploads/Resources/Tribal-low-res-for-view.pdf (Accessed 4/12/15).

  • Van de Poel, E., & Speybroeck, N. (2009). Decomposing malnutrition inequalities between scheduled castes and tribes and the remaining Indian population. Ethnicity & Health, 14(3), 271–287.

    Article  Google Scholar 

  • Victora, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L., et al. (2008). Maternal and child undernutrition: Consequences for adult health and human capital. The Lancet, 371(9609), 340–357.

    Article  Google Scholar 

  • Vidya, & Panjikkaran. (2018). Nutritional status of the tribal preschool children in Thrissur district. INDJSRT, 18, 62–66.

    Google Scholar 

  • World Health Organization. (2014). Global nutrition targets 2025: Stunting policy brief (No. WHO/NMH/NHD/14.3). World Health Organization.

  • Yue, A., Marsh, L., Zhou, H., Medina, A., Luo, R., Shi, Y., Zhang, L., Kenny, K., & Rozelle, S. (2016). Nutritional deficiencies, the absence of information and caregiver shortcomings: A qualitative analysis of infant feeding practices in rural China. PLOS ONE, 11(4), e0153385. https://doi.org/10.1371/journal.pone.0153385.

    Article  Google Scholar 

Download references

Acknowledgements

Authors would like to acknowledge Dr. Preeti Dhillon, Mr. Ajeet Kumar Singh, Dr. Rahul Bawankule, and Dr. S. Gowtham for their help in the finalization of the manuscript. The authors also sincerely acknowledge the reviewers whose comment helped to improve the paper.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India

    Pradeep Kumar & Adrita Banerjee

  2. School of Public Health, ICMR-National Institute of Epidemiology, Chennai, 77, India

    Harshal Sonekar & Nuzrath Jahan

Authors
  1. Pradeep Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harshal Sonekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adrita Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuzrath Jahan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrita Banerjee.

Ethics declarations

Conflict of Interest

The authors state that there is no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, P., Sonekar, H., Banerjee, A. et al. A Multilevel Analysis of Factors Associated with Malnutrition among Tribal Children in India: Evidence from National Family Health Survey 2015-16. Child Ind Res 14, 1547–1569 (2021). https://doi.org/10.1007/s12187-021-09812-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12187-021-09812-5

Keywords

Search

Navigation