Stunting and severe stunting among infants in India: the role of delayed introduction of complementary foods and community and household factors

ABSTRACT

Background: Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and associated factors are related to stunting and severe stunting among children in many low- and middle-income countries. In India, however, there is limited evidence on the relationship between delayed complementary feeding and associated factors with stunting and severe stunting to advocate for policy interventions.

Objectives: The present study investigated the relationship between delayed complementary feeding and associated factors with stunting and severe stunting among infants aged 6–8 months in India.

Methods: Survey data on 13,548 infants aged 6–8 months were obtained from the 2015–16 National Family Health Survey in India. Logistic regression (Generalized Linear Latent and Mixed Models [GLLAMM] with a logit link and binomial family) models that adjusted for clustering and sampling weights were used to investigate the relationship between delayed complementary feeding and associated factors (community, household, maternal, child and health service factors) with stunting and severe stunting among infants aged 6–8 months in India.

Results: The prevalence of stunting and severe stunting was 22.0% (95% CI: 21.0–23.7%) and 10.0% (95% CI: 9.0–11.0%) among infants aged 6–8 months who received no complementary foods, respectively. Delayed introduction of solid, semi-solid or soft foods was associated with stunting (adjusted Odd ratios [aOR] = 1.24, 95% CI: 1.09–1.41) and severe stunting (aOR = 1.21, 95% CI: 1.01–1.45) among infants aged 6–8 months. High maternal education (secondary or higher education) and household wealth (middle, richer and richest) were protective against stunting and severe stunting.

Conclusion: Delayed introduction of complementary foods and associated factors were related to stunting and severe stunting among infants aged 6–8 months in India. Reducing the proportion of infants who are stunted in India would require comprehensive national nutrition policy actions that target the sub-population of mothers with no schooling and limited resources.

KEYWORDS:

• Stunting
• delayed introduction of complementary feeding
• India
• infants
• nutrition

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

This study formed part of the first author’s Higher Degree Research studies at the Translational Health Research Institute, School of Medicine, Western Sydney University, Australia. We acknowledge the time and effort of Dr Elizabeth O’Connor in proofreading the entire revised manuscript. The authors are grateful to Measure DHS, ICF International, Rockville, Maryland, USA for providing the data for the analysis.

Author contributions

MVD contributed to the study conceptualisation, contributed to the data analysis, compiled and interpreted the results, drafted the initial manuscript and critically revised the manuscript as submitted. FAO contributed to the study conceptualisation, provided guidance on data analysis, contributed to drafting the original manuscript, interpreted data and critically revised the manuscript as submitted. ULO contributed to drafting the original manuscript, interpreted data and critically revised the manuscript as submitted. ZU interpreted data and critically revised the manuscript as submitted. KEA contributed to the study conceptualisation, provided guidance on data analysis, contributed to the data interpretation and critically revised the manuscript as submitted. All authors read and approved the final manuscript as submitted.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The Ethics Review Board at the International Institute for Population Sciences, Mumbai, India granted Measure DHS/ICF International ethical approvals before the surveys were conducted, with written informed consent obtained from participants during the surveys. The questionnaires used for the survey were reviewed and approved by ICF International Institutional Review Board (IRB) to ensure they met the United States Department of Health and Human Services regulations for the protection of human participants, as well as the host country’s IRB, to ensure compliance with national laws. The first author sought approval from Measure DHS and permission was granted for this use.

Paper context

There is limited evidence on the broader impact of delayed introduction of complementary foods in India. This paper examined the relationship between the delayed introduction of complementary foods and stunting and severe stunting among infants aged 6–8 months in India. Our study revealed that delayed introduction of complementary foods was associated with stunting and severe stunting among infants in India and supports calls for improvements in national childhood nutrition policy actions.

Additional information

Funding

This study received no specific grant from any funding agency in public, commercial or not-for-profit sectors. Felix Ogbo received early career research funding grant from the Office of the Deputy Vice Chancellor (Research and Innovation), Western Sydney University [0001].