Effect of the COVID-19 Pandemic on Anthropometric Outcomes in Indian Children: Retrospective Analysis of the 2019-2021 National Family Health Survey Data

Background: Disruptions in food, health, and economic systems during the COVID-19 pandemic may have adversely affected child health but such effects are poorly understood. Methods: We examined the short-term effect of the pandemic on anthropometric outcomes of under-5 children in India, using data from the fifth round of the National Family Health Survey which was conducted in two phases from June 2019 to January 2020, and January 2020 to April 2021 (no data collection occurred from April to October 2020 due to a nationwide lockdown). Children surveyed after October 2020 were considered as COVID-19 affected, while those surveyed before were considered unaffected. Differences in individual, family, and community level characteristics between the two groups were mitigated by using propensity score matching methods. Findings: COVID-affected children had 1.2% (95% CI: 0.4%-1.9%, p<0.01) higher underweight rates, 1.2% (0.5%-1.9%, p<0.01) lower wasting rates, 0.1 (0.06 – 0.13, p<0.01) lower height-for-age z-scores, and 0.04 (0.01 – 0.07, p<0.01) lower weight-for-height z-scores compared with matched COVID-unaffected children. Among COVID-affected children, those surveyed in 2020 had 1.6% (0.2%-2.9%, p<0.01) higher stunting rates, 4.6% (3.4%-5.9%, p<0.01) higher underweight rates, and 2.4% (1.3%-3.5%, p<0,01) higher wasting rates as compared with COVID-unaffected children. COVID-19 affected children from households in the two lowest wealth quintiles had the greatest reduction in height-for-age and weight-for-height z-scores. Interpretation: Investments in health and food systems, targeting low-income families, are essential for improving current child health outcomes and building resilience against future global health emergencies.