Sociodemographic determinants of malnutrition amongst under-five children: Insights for public health interventions

INTRODUCTION

Adequate nutrition is a fundamental human right and is especially critical for a child’s physical and cognitive development.^[1] Nutrition in the first 5 years of life plays a pivotal role in shaping a child’s long-term health, developmental outcomes and overall potential.^[2] This period is particularly sensitive, and nutritional deficiencies can have lasting consequences on a child’s physical and mental capabilities.^[3] The overall well-being and future prosperity of any nation are closely tied to the health and development of its youngest citizens.^[4]

Undernutrition amongst children continues to be a significant global public health issue, particularly in low- and middle-income nations.^[5] As of 2020, it was estimated that 21.3% of children under the age of five – approximately 144 million – were affected by stunting, 6.9% (47 million) experienced wasting and 5.6% (38 million) were classified as overweight.^[6] Despite India’s economic growth, malnutrition amongst children remains a critical issue, manifesting in multiple forms including undernutrition (stunting, wasting, and underweight), micronutrient deficiencies and overweight or obesity.^[7]

According to the National Family Health Survey (NFHS-5, 2019–2021), amongst children under five in India, 30% are stunted, 18.5% are wasted, 7.6% are severely wasted, 27.3% are underweight and 4.2% are overweight.^[8] These statistics highlight the complex and multifaceted nature of childhood malnutrition in the country.

Malnourished children are at risk not only for immediate health issues but also for long-term developmental delays, which may affect learning, social engagement and future economic productivity.^[3,4] Understanding the prevalence of undernutrition and its associated sociodemographic factors is crucial to identify at-risk populations and to inform targeted public health interventions.^[5,9] These efforts contribute to achieving Sustainable Development Goal.^[10]

Although several studies have examined the determinants of child malnutrition across India, there is a need to focus on specific regions like rural Bangalore, which presents unique contextual challenges. National and state-level data consistently show that rural areas report higher rates of stunting, wasting and underweight compared to urban areas.^[8] In rural Bangalore, limited access to healthcare, inconsistent implementation of nutritional programmes such as the Integrated Child Development Services (ICDS) and mid-day meal schemes and infrastructural constraints further aggravate the issue.^[8,11] Unlike more remote rural regions, rural Bangalore represents a transitional zone where rural poverty coexists with urban influence, potentially creating unique nutritional patterns, including a double burden of undernutrition and overweight.^[12,13]

However, there is a paucity of community-based studies specifically examining the nutritional status of children in rural Bangalore. Existing state-level and national surveys provide important overviews but do not capture local sociodemographic dynamics that influence child growth and development. Addressing this gap is critical to designing interventions tailored to the needs of vulnerable groups in this semi-urbanising rural context.

Hence, the present study was conducted to assess the nutritional status of children under-five years of age and to explore the sociodemographic factors influencing it in rural Bangalore. In addition to the long-standing burden of undernutrition, recent evidence indicates rising trends of overweight and obesity amongst Indian children, reflecting a nutrition transition. By generating region-specific evidence, the study aims to support the development of effective, targeted public health strategies to address childhood malnutrition in India.

MATERIAL AND METHODS

A community-based cross-sectional study was conducted in the field practice area. Five villages under the community practice area PHC were randomly selected, and 210 children under-five years of age were chosen using a convenience sampling technique. Given the resource and time constraints of a community-based study, convenience sampling was chosen as a pragmatic approach, while still ensuring inclusion of children across all households with eligible participants in the selected villages. From the literature review of a previous community study in Karnataka by Chittapur et al. (2024),^[21] the prevalence of stunting was reported as 35% in rural Yadgir. Expecting a similar prevalence in the present study, and using a 95% confidence level, an absolute precision of ≈6.6% yields a required sample size of 206. After rounding, the final sample size chosen for the study was 210 children.

The following criteria were considered while selecting participants in this study: (1) Healthy children under five years of age and (2) mothers who had been residing in the study area for not <3 consecutive years. Children currently undergoing treatment for chronic illnesses were excluded from the study to minimise confounding from disease-related malnutrition and focus on community-level determinants.

RESULTS

DISCUSSION

The present study reported a 16.7% prevalence of underweight, which is lower than the national average of 27.3% reported in NFHS-5 (2019–2021). Although relatively low, this still indicates a considerable burden of undernutrition. Similar findings were observed by Taneja et al. (2020) in Haryana (18%) and Agarwal et al. (2018) in urban Lucknow (22%),^[16,17,18] suggesting that areas with better healthcare and maternal awareness may exhibit lower underweight rates.

In contrast, the stunting prevalence was 31.9%, slightly exceeding the national average of 30%. Despite the marginal difference, the result is significant as it reflects chronic undernutrition. Studies by Meshram et al. (2019) in Maharashtra and Kapoor and Kumar (2018) in Uttar Pradesh^[19,20] similarly reported high stunting rates, particularly amongst socioeconomically disadvantaged children. These findings stress the importance of interventions during the first 1,000 days of life.

Wasting was observed in 21.9% of children, which is notably higher than the NFHS-5 national average of 18.5%, indicating acute malnutrition in the study area. Comparable results were reported by Bhagwat et al. (2021) and Taneja et al. (2020),^[16,21,22] who linked high wasting rates with infections, inadequate feeding and poor hygiene.

In the present study, 11% of under-five children were found to be overweight, which is substantially higher than national estimates and suggests an early stage of nutrition transition in rural Bangalore. According to the NFHS (NFHS-4, 2015–2016), only 2.6% of children under five in India were classified as overweight.^[23] A more recent trend analysis using NFHS-5 data reported a modest increase to approximately 4% nationally, yet this remains far below the prevalence observed in our study.^[24] These indicate that rural Bangalore may be experiencing a more pronounced double burden of malnutrition than many other regions in India, reinforcing the need for context-specific interventions that address both undernutrition and the emerging challenge of overweight.

A significant association was found between low birth weight and wasting (χ² = 7.408, P = 0.025), affirming earlier findings from Meshram et al. (2019)^[19] and NFHS-5,^[25] both of which identified low birth weight as a strong predictor of acute malnutrition. This highlights the importance of improving maternal nutrition and antenatal care.

Weight-for-age was significantly associated with the child’s age (χ² = 21.586, P = 0.042), with underweight more prevalent in the 6–12-month group. As age increased, normal and overweight proportions rose. Similar patterns were seen in Kapoor and Kumar (2018)^[20] and NFHS-5,^[25] which emphasise the need for timely complementary feeding during infancy.

Stunting was also significantly related to age group (χ² = 21.124, P = 0.007) and socioeconomic status (χ² = 19.699, P = 0.003), with higher rates amongst younger children and those from lower socioeconomic classes. This supports evidence from Bhagwat and Meshram et al. (2019) and Unisa (2016),^[19,21] highlighting poverty, food insecurity and poor feeding as major contributors. While gender showed borderline significance (P = 0.054), males had slightly higher stunting rates – consistent with CNNS (2016–2018),^[7] which suggested boys may be more vulnerable to growth faltering.

These findings collectively underline the need for age-specific, gender-sensitive and equity-focused nutrition interventions, especially in early childhood and amongst economically disadvantaged groups.

CONCLUSION

The research unveiled that the prevalence of undernutrition amongst children under-five years of age was quite high and also shows disparities in nutritional status amongst different socioeconomic groups, age and gender. This information can serve as a compass, guiding targeted interventions and allocation of resources towards the vulnerable population and reducing health inequalities. Ultimately, it helps in achieving SDG-2, which focuses on zero hunger by 2030.