Malnourished children? Child health disparities and its causes in Eastern India

The disparity in child health outcomes across Indian districts, particularly in Eastern India, is alarming. Approximately half of the districts in this region exhibit very poor child health outcomes, evidenced by alarmingly high neonatal, infant, and under-five mortality rates. This study analyses the existing levels and patterns of child health outcomes across 112 districts of Eastern India, a region known for its low levels of child health status. To do this, we have constructed a composite child health index (CHI) using nationally representative data from the National Family Health Survey (NFHS-5). Using Principal Component Analysis, the study uses the CHI values to categorize the districts into high, moderate, and low-performing districts. The results show a significant variation in CHI outcomes across the districts, with striking regional disparities. Notably, all high-performing districts were located only in the state of Odisha. In contrast, a substantial proportion of the low-performing districts were in the state of Bihar, suggesting systemic healthcare deficiencies. Using discriminant function analysis, we obtain the critical determinants of CHI to be sanitation facilities, mother's education, marriage before 18 years, and low body mass index of the mother. Our findings confirm that improvements in these areas are crucial for enhancing child health outcomes and ending intergenerational transmission of poor health outcomes. The implications of this study extend beyond eastern India, offering valuable insights into similar challenges in global low- and middle-income regions.