Determinants of stunting in children aged 6–23 months in India’s highest nutritional burden states (Uttar Pradesh, Bihar, and Jharkhand)

Authors

  • Asha Lavanya Department of Nutrition and Dietetics, Manav Rachna International Institute of Research and Studies, India Author
  • Ishan Rohan Department of Nutrition and Dietetics, Manav Rachna International Institute of Research and Studies, India Author
  • Kiran Laksman Department of Nutrition and Dietetics, Manav Rachna International Institute of Research and Studies, India Author
  • Abimayu Devan Department of Nutrition and Dietetics, Manav Rachna International Institute of Research and Studies, India Author

DOI DOI

https://doi.org/10.64146/tbtkkt69

Keywords:

Stunting, children 6–23 months, ase–control study, complementary feeding, social determinants, empowered Action Group states

Abstract

Stunting remains the most prevalent chronic undernutrition among Indian children, and Uttar Pradesh, Bihar and Jharkhand carry a disproportionate share of this burden. This study aimed to identify the independent nutritional, maternal and environmental determinants of stunting among children aged six to twenty-three months in these high-burden states and to explain the constraints shaping child feeding. A convergent mixed-methods study was conducted in purposively selected rural and peri-urban districts. The quantitative strand used a community-based case-control design of four hundred twenty matched pairs, comprising eight hundred forty children matched on village cluster and sex, with cases defined by a length-for-age Z score below minus two. Trained interviewers administered a validated structured questionnaire covering socio-demographic, feeding, maternal, antenatal and environmental exposures, complemented by twenty-four in-depth interviews and six focus group discussions conducted until thematic saturation. Data were analysed using univariable and multivariable conditional logistic regression in Stata 17 alongside inductive and deductive thematic coding. Low birth weight and short maternal stature were the strongest determinants, followed by household poverty, inadequate dietary diversity and older infant age. Stunting reflects intergenerational, dietary and structural factors requiring integrated maternal, feeding and sanitation interventions.

References

Acharya, A., Pradhan, M. R., & Das, A. K. (2021). Determinants of minimum acceptable diet feeding among children aged 6–23 months in Odisha, India. Public Health Nutrition, 24(12), 3834–3844. https://doi.org/10.1017/S1368980021002172 DOI: https://doi.org/10.1017/S1368980021002172

Ayue, H. I., Nurdiana, N., Wardhani, V., Astuti, A. B., Prayitno, H., Laksono, A. D., & Sundjaya, T. (2025). Exploring the multifactorial predictors of stunting in children under five: A systematic review of the literature, 2015–2024. Journal of Public Health Research, 14(2). https://doi.org/10.1177/22799036251403945 DOI: https://doi.org/10.1177/22799036251403945

Basu Roy, T., Das, T., Das, P., & Das, P. (2023). Analyzing determinants from both compositional and contextual level impeding desired linear growth of children in Indian context. BMC Nutrition, 9(1), 78. https://doi.org/10.1186/s40795-023-00725-w DOI: https://doi.org/10.1186/s40795-023-00725-w

Bera, T., Mohanty, G., Patra, K. T., Dash, K., & Dwivedi, R. (2025). Dietary diversity and malnutrition status of children in India: A caste-based analysis. In J. Pradhan (Ed.), Nutrition and food security in India. Springer. https://doi.org/10.1007/978-981-96-7230-1_13 DOI: https://doi.org/10.1007/978-981-96-7230-1_13

Cahyani, I. (2025). The Relationship between Diet and the Incidence of Gastroesophageal Reflux Disease in Boarding School Students. HealthSmart: Jurnal Kesehatan Masyarakat, 1(1), 1–13. https://doi.org/10.64146/WN1XN988 DOI: https://doi.org/10.64146/wn1xn988

Chandratika, I. (2025). Effectiveness of Moringa Extract Liquid Supplement on Increasing Children’s Appetite in the Cerdas and Insani Playgroup. Jurnal Gizi Dan Teknologi Pangan : Nutrismart, 1(1), 36–51. https://doi.org/10.64146/3483VP48 DOI: https://doi.org/10.64146/3483vp48

Daryati, M. E., Sari, J. P., Nasution, S. T., & Wahyuni, I. (2026). Development of a Mobile Application-Based Food Parenting Guide Educational Media to Improve Mothers’ Knowledge of Balanced Nutrition for Toddlers. HealthSmart: Jurnal Kesehatan Masyarakat, 2(1), 75–88. https://doi.org/10.64146/9CTEMY69 DOI: https://doi.org/10.64146/9ctemy69

Daryati, M., Hamzah, & Sari, D. L. (2026). The Relationship Between Nutrition Knowledge and Feeding Style with Nutritional Status in Early Childhood Education Institutions. Jurnal Gizi Dan Teknologi Pangan : Nutrismart, 2(1), 1–14. https://doi.org/10.64146/XN7MQ741 DOI: https://doi.org/10.64146/xn7mq741

Daryati, M., & Suryadi, D. (2025). The Effect of Nutrition Education Using Picture Media on Vegetable and Fruit Consumption in Early Childhood. Jurnal Gizi Dan Teknologi Pangan : Nutrismart, 1(1), 13–24. https://doi.org/10.64146/920ZBF07 DOI: https://doi.org/10.64146/920zbf07

Dolui, M., & Sarkar, S. (2024). Decomposing social group differences in stunting among children under five years of age in India using a nationally representative data sample. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-78796-3 DOI: https://doi.org/10.1038/s41598-024-78796-3

Eka Daryati, M., & Sadiana, M. (2025). The Influence of Cooking Activities on the Introduction of Healthy Food for Early Childhood Education. HealthSmart: Jurnal Kesehatan Masyarakat, 1(1), 14–26. https://doi.org/10.64146/1JS56E90 DOI: https://doi.org/10.64146/1js56e90

Fadillah, & Suryadi, D. (2025). The Relationship Between Parenting Patterns and Balanced Nutritional Intake with Nutritional Status of Young Children. HealthSmart: Jurnal Kesehatan Masyarakat, 1(1), 52–65. https://doi.org/10.64146/7G6T1B06 DOI: https://doi.org/10.64146/7g6t1b06

Gunnal, G., Bagaria, D., & Roy, S. (2024). Regional patterns in minimum diet diversity failure and associated factors among children aged 6–23 months in India. The National Medical Journal of India, 37(4), 181–190. https://doi.org/10.25259/NMJI_241_2023 DOI: https://doi.org/10.25259/NMJI_241_2023

Halli, S. S., Biradar, R. A., & Prasad, J. B. (2022). Low birth weight as a differentiating risk factor for stunting among preschool children in India. International Journal of Environmental Research and Public Health, 19(7), 3751. https://doi.org/10.3390/ijerph19073751 DOI: https://doi.org/10.3390/ijerph19073751

Harjadinta, & Susanty, Y. E. (2025). The Role of Fast-Food Consumption Patterns in The Incidence of Obesity in Adolescents. HealthSmart: Jurnal Kesehatan Masyarakat, 1(1), 66–77. https://doi.org/10.64146/0GR58S35 DOI: https://doi.org/10.64146/0gr58s35

Ihsan, H., Anggraini, W., & Yanuarti, R. (2026). Influence Educational Module on Stunting Prevention and Level of Knowledge of Maternal Behavior in the First 1000 Days of Life for Recipients of the Family Hope Program. HealthSmart: Jurnal Kesehatan Masyarakat, 2(1). https://doi.org/10.64146/1TZBH515 DOI: https://doi.org/10.64146/1tzbh515

International Institute for Population Sciences (IIPS), & ICF. (2021). National Family Health Survey (NFHS-5), 2019–21: India, Volume I. http://rchiips.org/nfhs/nfhs5.shtml https://doi.org/10.2139/ssrn.5230068 DOI: https://doi.org/10.2139/ssrn.5230068

Jain, L., Pradhan, S., Aggarwal, A., Padhi, B. K., Itumalla, R., Khatib, M. N., Gaidhane, S., Zahiruddin, Q. S., Santos, C. A. G., Al-Mugheed, K., Alrahbeni, T., Kukreti, N., Satapathy, P., Rustagi, S., Heidler, P., & Marzo, R. R. (2024). Association of child growth failure indicators with household sanitation practices in India (1998–2021): Spatiotemporal observational study. JMIR Public Health and Surveillance, 10, e41567. https://doi.org/10.2196/41567 DOI: https://doi.org/10.2196/41567

Karlsson, O., Kim, R., Sarwal, R., James, K. S., & Subramanian, S. V. (2021). Trends in underweight, stunting, and wasting prevalence and inequality among children under three in Indian states, 1993–2016. Scientific Reports, 11, 14137. https://doi.org/10.1038/s41598-021-93493-1 DOI: https://doi.org/10.1038/s41598-021-93493-1

Khan, J., & Mohanty, S. K. (2024). Poverty induced inequality in nutrition among children born during 2010–2021 in India. PLOS ONE, 19(11), e0313596. https://doi.org/10.1371/journal.pone.0313596 DOI: https://doi.org/10.1371/journal.pone.0313596

Khura, B., Mohanty, P., Gandhi, A. P., Patnaik, L., Mewara, A., Pradhan, K. B., & Padhi, B. K. (2023). Mapping concurrent wasting and stunting among children under five in India: A multilevel analysis. International Journal of Public Health, 68, 1605654. https://doi.org/10.3389/ijph.2023.1605654 DOI: https://doi.org/10.3389/ijph.2023.1605654

Kumar, R. P., Selvamani, Y., & Singh, H. (2025). Integrated Child Development Services (ICDS) and their contribution to improving complementary feeding practices among children aged 6–23 months in India: Insights from a nationally representative survey. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-25884-2 DOI: https://doi.org/10.1186/s12889-025-25884-2

Kundu, R. N., Chatterjee, A., Bharati, S., Pal, M., Hossain, M. G., & Bharati, P. (2024). Zonal distribution and determinants of stunting, wasting, underweight, and thinness among the Indian under-five children: Findings from NFHS-5. In M. Pal, M. G. Hossain, R. A. Mahumud, & P. Bharati (Eds.), Public health and nutrition. Springer. https://doi.org/10.1007/978-981-97-7890-4_6 DOI: https://doi.org/10.1007/978-981-97-7890-4_6

Kundu, R. N., Gautam, R. K., Chatterjee, A., Bharati, P., Liczbińska, G., & Malina, R. M. (2024). Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys. European Journal of Clinical Nutrition, 78(7), 591–606. https://doi.org/10.1038/s41430-024-01427-7 DOI: https://doi.org/10.1038/s41430-024-01427-7

Petrikova, I. (2022). The role of complementary feeding in India’s high child malnutrition rates: Findings from a comprehensive analysis of NFHS-IV (2015–2016) data. Food Security, 14(1), 39–66. https://doi.org/10.1007/s12571-021-01202-7 DOI: https://doi.org/10.1007/s12571-021-01202-7

Rai, R. K., Kumar, S. S., & Kumar, C. (2022). Factors associated with minimum dietary diversity failure among Indian children. Journal of Nutritional Science, 11, e4. https://doi.org/10.1017/jns.2022.2 DOI: https://doi.org/10.1017/jns.2022.2

Ramasubramani, P., Krishnamoorthy, Y., & Rajaa, S. (2024). Prevalence and socio-demographic factors associated with double and triple burden of malnutrition among mother–child pairs in India: Findings from a nationally representative survey (NFHS-5). Heliyon, 10(18), e37794. https://doi.org/10.1016/j.heliyon.2024.e37794 DOI: https://doi.org/10.1016/j.heliyon.2024.e37794

Rao, N., Bala, M., Ranganathan, N., Anand, U., Dhingra, S., Costa, J. C., Menon, P., & Avula, R. (2023). Trends in the prevalence and social determinants of stunting in India, 2005–2021: Findings from three rounds of the National Family Health Survey. BMJ Nutrition, Prevention & Health, 6(2), 357–366. https://doi.org/10.1136/bmjnph-2023-000648 DOI: https://doi.org/10.1136/bmjnph-2023-000648

Riazi, S., Ghavami, V., Sobhani, S. R., Alinezhad-Namaghi, M., & Eslami, S. (2024). The effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women: A semi-experimental study. BMC Pregnancy and Childbirth, 24, 700. https://doi.org/10.1186/s12884-024-06728-0 DOI: https://doi.org/10.1186/s12884-024-06728-0

Saha, J., Chouhan, P., Malik, N. I., Ghosh, T., Das, P., Shahid, M., Ahmed, F., & Tang, K. (2022). Effects of dietary diversity on growth outcomes of children aged 6 to 23 months in India: results from the National Health and Family Survey. Nutrients, 15(1), 159. https://doi.org/10.3390/nu15010159

Saha, J., Chouhan, P., Malik, N. I., Ghosh, T., Das, P., Shahid, M., Ahmed, F., & Tang, K. (2023). Effects of dietary diversity on growth outcomes of children aged 6 to 23 months in India: Evidence from National Family and Health Survey. Nutrients, 15(1), 159. https://doi.org/10.3390/nu15010159 DOI: https://doi.org/10.3390/nu15010159

Sharma, D., Vijin, P. P., Goyal, R., Hadi, S. U., & Kumar, R. (2025). Unveiling subgroup trends of stunting and wasting in Indian children: A serial cross-sectional analysis from National Family Health Surveys 3–5. The American Journal of Clinical Nutrition. https://doi.org/10.1016/j.ajcnut.2025.01.027 DOI: https://doi.org/10.1016/j.ajcnut.2025.01.027

Singh, K. J., Chiero, V., Kriina, M., Alee, N. T., & Chauhan, K. (2022). Identifying the trend of persistent cluster of stunting, wasting, and underweight among children under five years in northeastern states of India. Clinical Epidemiology and Global Health, 18, 101158. https://doi.org/10.1016/j.cegh.2022.101158 DOI: https://doi.org/10.1016/j.cegh.2022.101158

UNICEF, WHO, & World Bank. (2023). Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group joint child malnutrition estimates Key findings of the 2023 edition. https://data.unicef.org/resources/jme-report-2023/

World Health Organization. (2023). WHO guideline for complementary feeding of infants and young children 6–23 months of age. https://www.who.int/publications/i/item/9789240081864 https://doi.org/10.1093/nutrit/nuaa143 DOI: https://doi.org/10.1093/nutrit/nuaa143

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Published

31-07-2026

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Vol. 2 No. 2 (2026): Nutrismart July Edition

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Copyright (c) 2026 Asha Lavanya, Ishan Rohan, Kiran Laksman, Abimayu Devan (Author)

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How to Cite

Lavanya, A. ., Rohan, I. ., Laksman, K. ., & Devan, A. (2026). Determinants of stunting in children aged 6–23 months in India’s highest nutritional burden states (Uttar Pradesh, Bihar, and Jharkhand). Jurnal Gizi Dan Teknologi Pangan : Nutrismart, 2(2), 124-140. https://doi.org/10.64146/tbtkkt69