Examining the Prevalence and Predictors of Stunting in Indian Children: A Spatial and Multilevel Analysis Approach

Stunting is a complex issue in India that has deep-seated health, social, and economic causes. The problem of stunting is a clear indicator of chronic undernutrition and has long-term impacts on both individuals and society. Identifying hot-spot areas with the highest stunting prevalence among children is important for addressing the multifaceted issue of childhood stunting in India. Therefore, we conducted a study to analyze the spatial distribution and identify the predictors of stunted children in India using spatial and multilevel analysis. We analyzed data from the National Family Health Survey-5 and included a sample size of 201,276 children (aged 0–59 months) in 707 districts, 28 states, 8 union territories, and 30,198 clusters throughout India. From Getis-Ord hot spot analysis, we identified Meghalaya, Bihar, Uttar Pradesh, Jharkhand, Assam, Gujarat, Odisha, Madhya Pradesh, Rajasthan, Chhattisgarh, Karnataka, Telangana, and Andhra Pradesh as the hot-spot areas in India for childhood stunting. The study’s findings could be used to develop targeted interventions and strategies to reduce stunting in identified hot-spot areas of India. From multilevel logistic regression analysis, we found that stunting prevalence was greater among male children aged 12–59 months in India, especially those born to young, underweight, uneducated mothers, households with poor sanitation facilities, larger family sizes, and the poorest wealth index. We must prioritize the effective implementation of policies aimed at improving maternal education and basic sanitation facilities, reducing family size, and enhancing the socioeconomic conditions of the poorest households to significantly reduce stunting in India.