Individual-level double burden of malnutrition among children in India: Evidence from Comprehensive National Nutrition Survey (CNNS), 2016-18

Abstract Background While different forms of malnutrition exist around the world, the present study aimed to assess the prevalence of stunting, overweight or obesity and double burden of malnutrition (DBM). As well, the study aimed to identify the factors associated with DBM. Further, the study also estimated the burden of DBM at the national and state-level. Methods The study used data from the 2016–2018 Comprehensive National Nutrition Survey (CNNS) conducted across 30 Indian states. The CNNS survey collected data on anthropometric and other socio-demographic indicators of 76,415 children. The outcome variable of interest of DBM is define as the co-existence of stunting and overweight among children aged 0–9 years. Children whose height-for-age was at least 2 standard deviation below the mean for their age were classified as ‘stunted’ and those whose weight-for-age was more than 2 standard deviation above the mean were classified as overweight or obese. A binary variable was created if the child had both conditions. Results The prevalence of stunting, overweight and DBM was 28.2%, 4.9% and 1.9%, respectively. Despite low prevalence of DBM, 4.4 million children are double burdened in India. Male children had higher odds of being malnourished. Further, mother’s age, parity, wealth index and caste were significantly associated with children being stunted, overweight or obese and DBM. Mother’s education was significantly associated with stunting and overweight. Conclusion This study provides evidence that Indian children are experiencing DBM. Therefore, nutrition initiatives in the country need to strategies and remodel standalone interventions to tackle under-nutrition and overweight concurrently.