Objectives To assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021. Methods We leveraged data from three rounds of the National Family Health Survey (NFHS-3: 2005–2006, NFHS-4: 2015–2016, NFHS-5: 2019–2021) for 443 038 children under 5 years. Adjusted logistic regression models and a Kitigawa-Oaxaca-Blinder decomposition were deployed to examine how wealth, residence, belonging to a marginalised social group, maternal education and child sex contributed to changes in stunting prevalence. Results The decrease in stunting prevalence was notably slower between NFHS-4 and NFHS-5 (annual average rate of reduction (AARR): 1.33%) than between NFHS-3 and NFHS-4 (AARR: 2.20%). The protective effect of high wealth diminished from 2015 onwards but persisted for high maternal education. However, an intersection of higher household wealth and maternal education mitigated stunting to a greater extent than either factor in isolation. Residence only predicted stunting in 2005–2006 with an urban disadvantage (adjusted OR: 1.18; 95% CI: 1.07 to 1.29). Children from marginalised social groups displayed increased likelihoods of stunting, from 6–16% in 2005–2006 to 11–21% in 2015–2016 and 2020–2021. Being male was associated with 6% and 7% increased odds of stunting in 2015–2016 and 2019–2021, respectively. Increased household wealth (45%) and maternal education (14%) contributed to decreased stunting prevalence between 2005 and 2021. Conclusions Stunting prevalence in India has decreased across social groups. However, social disparities in stunting persist and are exacerbated by intersections of low household wealth, maternal education and being from a marginalised social group. Increased survival must be accompanied by needs-based interventions to support children and mitigate mutually reinforcing sources of inequality. Data are available in a public, open access repository. Data are available upon reasonable request. Data described in this study is from the NFHS. NFHS datasets are freely available from . Stata codes are available via NRao upon reasonable request.

中文翻译：

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2005-2021 年印度发育迟缓的患病率趋势和社会决定因素：三轮全国家庭健康调查的结果


目标 评估 2005 年至 2021 年间印度发育迟缓的社会决定因素以及社会人口因素对全国患病率趋势的影响变化。 方法 我们利用三轮全国家庭健康调查 (NFHS-3：2005-2006 年， NFHS-4：2015-2016 年，NFHS-5：2019-2021 年）针对 443 038 名 5 岁以下儿童。采用调整后的逻辑回归模型和基蒂川-瓦哈卡-布林德分解来研究财富、居住、属于边缘化社会群体、孕产妇教育和儿童性别如何影响发育迟缓患病率的变化。结果 NFHS-4 和 NFHS-5 之间的发育迟缓患病率下降速度明显慢于 NFHS-3 和 NFHS-4 之间的下降速度（AARR：2.20%）（年平均下降率（AARR）：1.33%）。自2015年起，高财富的保护作用逐渐减弱，但对高孕产妇教育的保护作用持续存在。然而，较高的家庭财富和母亲教育的结合比任何一个单独因素都更能减轻发育迟缓。 Residence仅预测2005-2006年的发育迟缓，城市处于劣势（调整后的OR：1.18；95% CI：1.07至1.29）。来自边缘化社会群体的儿童发育迟缓的可能性有所增加，从 2005-2006 年的 6-16% 上升到 2015-2016 年和 2020-2021 年的 11-21%。 2015-2016 年和 2019-2021 年，男性与发育迟缓的几率分别增加 6% 和 7%。 2005 年至 2021 年间，家庭财富 (45%) 和孕产妇教育 (14%) 的增加导致发育迟缓发生率下降。结论 印度各个社会群体的发育迟缓发生率均有所下降。然而，发育迟缓方面的社会差异仍然存在，并且由于家庭财富低、母亲教育程度低以及来自边缘社会群体等因素的交叉作用而加剧。 提高生存率必须伴随着基于需求的干预措施，以支持儿童并减少相互强化的不平等根源。数据可在公共、开放访问存储库中获取。数据可根据合理要求提供。本研究中描述的数据来自 NFHS。 NFHS 数据集可免费获取。根据合理要求，可通过 NRao 获取 Stata 代码。