Focusing on villages is a must for India to efficiently tackle child undernutrition

May 30, 2021
Children play in the Ranish Kalan village in India. (AP Photo/Manish Swarup)

Children play in the Ranish Kalan village in India. (AP Photo/Manish Swarup)

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Precision mapping of child undernutrition for nearly 600,000 villages in India shows that policy decisions to treat child anthropometric failure, such as growth stunting, wasting and child underweight, should focus on villages, the smallest local governance unit in India, rather than districts.

The research, published May 4 in the Proceedings of the National Academy of Sciences, is the first to quantify the local burden of child undernutrition and identify hotspots that require policy prioritization. The study found that within any given district, there are a mix of villages with high and low levels of child undernutrition and, between villages, there is a high level of variability of child anthropometric failure, indicating that health programs and policy decisions aren't reaching some of the hotspots for child underweight, stunting and wasting. 

Stunting is the impaired growth and development that children experience from poor nutrition and other factors such as repeated infections. Wasting is when a person or a part of their body becomes progressively weaker. 

India makes up almost 1/3 of the global prevalence in growth stunting, and child and maternal malnutrition within the country remains the leading risk factor for lost years of health, accounting for 15% of the risk, according to the study. 

In an effort to address and reduce child undernutrition and stunting, India's government launched the National Nutrition Mission in 2018, with aims of reducing child undernutrition by at least 2% per year and reducing the rate of stunting from 38.4% to 25% by 2022. However, these efforts are being directed at districts made up of, on average, 1,000 villages, with 1.3 million people in rural areas per district.  

While prior research has studied the variability of undernutrition within districts, there has not been an attempt to provide estimates of undernutrition indicators at the local village level. The researchers of the present study set out to fill this knowledge gap in an effort to help policymakers identify and precisely target the high-burden villages, Rockli Kim and S. V. Subramanian, co-authors of the paper, told The Academic Times. Kim is an assistant professor at Korea University, and Subramanian is a professor at Harvard University.

As such, this research is the first to produce predictions of child anthropometric failure for all individual villages in India; the mapping produced by the researchers has massive potential for real-world policy decisions being made in India today. 

The study used various data sources to map child undernutrition in 597,121 Indian villages, including India's 2011 census for village-level demographic and amenities data and the 2016 Indian Demographic and Health Survey, which had randomly displaced GPS locations of survey clusters. 

The researchers found that 54.2% to 72.3% of the total geographic variation in predicted child anthropometric failure was attributed to the village level, whereas only 20.6% to 39.5% of the geographic variation was attributed to the state level, indicating that child nutrition efforts should focus on targeting individual villages rather than districts at large. 

The researchers also found hotspots that deserve particular attention from policymakers. For example, examining child underweight, the researchers found that high burden villages were located in the central and northern regions of India. Moreover, the state of Uttar Pradesh, which contains 97,810 villages, had one of the highest prevalences of stunting, at 42.3%. 

The researchers also observed substantial variation across villages in child anthropometric failures, which "was somewhat expected, but still surprising," Kim and Subramanian said. For example, the predicted stunting ranges from less than 5% for 691 villages and over 70% for 453 other villages. 

One limitation of this research is that, since the GPS locations of Demographic and Health Survey clusters were randomly displaced in the data, it was not possible to exactly identify the corresponding census village for all clusters. Thus, the researchers said more fieldwork and data collection at the village level is necessary in order to validate their estimates further. 

This mapping posits that targeting specific hotspots that have high levels of child anthropometric failure and focusing on villages rather than districts would be more informative and more effective in India's efforts to address child undernutrition in the country. 

The researchers suggest that India's child undernutrition campaigns should break with the "traditional one-size-fits-all approaches," and India should tailor health programs to local needs, which are going to be much more efficient in combating these issues. 

"We hope our estimates at the village level can potentially shift the paradigm of policy discussion in India by enabling more informed prioritization and precise targeting," Kim and Subramanian said. "We strongly urge others to apply our methodology to other health and social indicators, and for other contexts, after careful assessment and tuning."

The study "Precision mapping child undernutrition for nearly 600,000 inhabited census villages in India," published May 4 in the Proceedings of the National Academy of Sciences, was authored by Rockli Kim, Korea University and Harvard University; Avleen S. Bijral and Juan M. Lavista Ferres, Microsoft AI For Good Research Lab; Yun Xu, SuperMap Software Co. Ltd; Xiuyuan Zhang, Peking University; Jeffrey C. Blossom and Gary King, Harvard University; Akshay Swaminathan, Flatiron Health; Alok Kumar, Department of Medical Health and Family Welfare; Rakesh Sarwal, National Institution for Transforming India Aayog; S. V. Subramanian, Harvard University and National Institution for Transforming India Aayog.