Changing Patterns of Severe Acute Malnutrition and Associated Socio-Demographic Factors Among Under-Five Children in Maharashtra

Abstract Background: Malnutrition poses a significant health concern, particularly among children under the age of five, on a global scale. Among the various forms of malnutrition, Severe Acute Malnutrition (SAM) stands out as one of the most devastating conditions, contributing to an 11-fold greater risk of mortality and morbidity in affected children than in well-nourished children. Despite being regarded as one of India's most economically developed states, Maharashtra continues to experience a persistently high prevalence of SAM. Recognizing this, there is a necessity to delve into the evolving trends of SAM in Maharashtra and explore the factors influencing its prevalence. Materials and Methods: In this study, the focus was on children aged 6 to 59 months who were residents of the state of Maharashtra. The information was obtained from the National Family Health Survey-4 (NFHS-4, 2015-16) and NFHS-5 (2019-21) databases. Bivariate analysis was conducted to determine the association between socio-demographic variables and SAM between NFHS-4 and NFHS-5 in Maharashtra. The multivariable binary logistic regression analysis was used to study the significant factors associated with the rising trend in SAM between the two survey periods. Results: The analysis showed that the SAM prevalence in Maharashtra has increased from 9.4% to 10.9% since NFHS-4. Bivariate analysis revealed that factors such as the wealth index, total number of children, media exposure of mothers, birth order, birthplace, and birth weight of the child were significant factors during NFHS-4, whereas, during NFHS-5, birth order and child age were the only factors that were found to be significant. The multivariable logistic regression model showed that maternal education and birth weight were the only factors that had a consistently significant association with SAM between the two survey periods (p<0.05). Conclusion: This study showed that despite the nutrition-sensitive policies and efforts of the Maharashtra government, the level of SAM among children is increasing. The observations from the study underscore the necessity of implementing nutrition-specific measures that target the underlying social issues in the state. Addressing these social determinants is crucial to overcoming the challenges associated with SAM effectively.