Multidimensional determinants of malnutrition among under five children in western India

Abstract

Background: Child undernutrition remains a major public health challenge in India despite multiple nutrition programs. Emerging evidence suggests that beyond dietary factors, maternal mental health, environmental, and digital vulnerabilities also influence child nutritional outcomes. This study aimed to assess the association of multidimensional deprivation, maternal, environmental, and digital determinants with malnutrition among under-five children in Ahmedabad district, Gujarat. Methods: A community-based cross-sectional study was conducted among 450 under-five children using multistage random sampling. Anthropometric measurements were performed following WHO protocols. Nutritional status was classified using WHO growth standards. Data on maternal education, depressive symptoms (PHQ-9), infant and young child feeding (IYCF) practices, household environmental vulnerability, digital access, and Multidimensional Deprivation Index (MDI) were collected. Chi-square test and multivariable logistic regression were applied. Results: Overall prevalence of stunting, underweight, and wasting were 34.2%, 28.5%, and 17.8%, respectively. Maternal depressive symptoms (AOR = 1.96, 95% CI 1.10–3.49), low maternal education, poor dietary diversity (< 4 food groups), environmental vulnerability, and higher multidimensional deprivation were significantly associated with malnutrition. Digital vulnerability (lack of access to mobile-based health information) was independently linked with stunting (AOR = 1.72, 95% CI 1.03–2.89). Children from least deprived households had significantly better nutritional status. Conclusion: Child malnutrition in Ahmedabad is driven by intersecting maternal, environmental, and socioeconomic vulnerabilities. Addressing maternal depression, enhancing dietary diversity, improving digital access, and building climate-resilient and socially inclusive nutrition strategies are essential to accelerate progress toward SDG-2.