Skip to main content
Log in

Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys

Indian Journal of Pediatrics Aims and scope Submit manuscript

Cite this article



To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4).


National Family Health Survey data from 4 rounds (1992–2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under −2 z score were classified as malnourished by HAZ, WAZ and WHZ.


A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (−2.1 ± 1.8 to −1.5 ± 1.7) but relatively less improved weight for age (−1.8 ± 1.4 to −1.5 ± 1.2), the change in wasting status was either nil or meagre (−0.8 ± 1.4 to −0.9 ± 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4th NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05).


Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Data Availability

The data that support the findings of this study are openly available at


  1. Aayog NITI. Nourishing India-National Nutrition Strategy. Government of India: New Delhi, India. 2017. Available at: Accessed on 15 July 2021.

  2. Bhattacharya S. K. Perspective of Recent Advances in Acute Diarrhea. London: IntechOpen; 2020. p.108

  3. Srivastava S, Upadhyay AK. A success story of reduction in childhood stunting and underweight in india: analysis of pooled data from three rounds of indian demographic and health surveys (1998–2016). J Biosoc Sci. 2022;54:106–23.

    Article  PubMed  Google Scholar 

  4. Madan EM, Frongillo EA, Unisa S, et al. Effect of differences in month and location of measurement in estimating prevalence and trend of wasting and stunting in India in 2005–2006 and 2015–2016. Curr Dev Nutr. 2020;4:1–7.

    Article  Google Scholar 

  5. Striessnig E, Bora JK. Under-five child growth and nutrition status: spatial clustering of indian districts. Spat Demogr. 2020;8:63–84.

    Article  Google Scholar 

  6. Yadav SS, Yadav ST, Mishra P, Mittal A, Kumar R, Singh J. An epidemiological study of malnutrition among under five children of rural and urban Haryana. J Clin Diagnostic Res. 2016;10:LC07–10.

  7. Smith LC, Ruel MT, Ndiaye A. Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Dev. 2005;33:1285–305.

    Article  Google Scholar 

  8. World Health Organization. WHO technical report series 854: Physical status: the use and interpretation of anthropometry. In: World Health Organization. 1995. Available at: Accessed on 15 July 2021.

  9. Caulfield LE, Richard SA, Rivera JA, et al. Stunting, wasting, and micronutrient deficiency disorders. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd ed. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; New York: Oxford University Press. 2006. p. 551–67.

  10. World Health Organization. Global nutrition targets 2025: wasting policy brief. WHO. 2014. Available at: Accessed on 15 July 2021.

  11. Khara T, Mwangome M, Ngari M, Dolan C. Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6–59 months from 84 countries. Matern Child Nutr. 2018;14:e12516.

  12. Wamani H, Åstrøm AN, Peterson S, Tumwine JK, Tylleskär T. Boys are more stunted than girls in Sub-Saharan Africa: A meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007;7:17.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Thurstans S, Opondo C, Seal A, et al. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob Heal. 2020;5:e004030.

  14. Abdulahi A, Shab-Bidar S, Rezaei S, Djafarian K. Nutritional status of under five children in ethiopia: a systematic review and meta-analysis. Ethiop J Health Sci. 2017;27:175–88.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, wasting and underweight in Sub-Saharan Africa: A systematic review. Int J Environ Res Public Health. 2017;14:863.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fagbamigbe AF, Kandala NB, Uthman AO. Demystifying the factors associated with rural–urban gaps in severe acute malnutrition among under-five children in low- and middle-income countries: a decomposition analysis. Sci Rep. 2020;10:11172.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Khan T, Khan REA, Raza MA. Gender analysis of malnutrition: a case study of school-going children in Bahawalpur. Asian Dev Policy Rev. 2015;3:29–48.

    Article  Google Scholar 

  18. Man SL, Guo Y. Research on the social determinants of malnutrition among children under the age of 5 in China. Beijing Da Xue Xue Bao Yi Xue Ban. 2016;48:418–23.

    PubMed  Google Scholar 

  19. Srinivasan CS, Zanello G, Shankar B. Rural-urban disparities in child nutrition in Bangladesh and Nepal. BMC Public Health. 2013;13:581.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Olofin I, McDonald CM, Ezzati M. Nutrition Impact Model Study (anthropometry cohort pooling). et al. Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies. PLoS One. 2013;8:e64636.

  21. McDonald CM, Olofin I, Flaxman S, et al. Nutrition Impact Model Study. The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr. 2013;97:896–901.

  22. Shuja S, Ategbo EA, Ihtesham Y, Ahmed KM. Wasting prevention and treatment – central to stunting reduction in Pakistan. Emerg Nutr Netw. 2020. Available at: Accessed on 1 Aug 2021.

Download references


The authors thank the Demographic and Health Surveys (DHS) program for NFHS 4 data.



Author information

Authors and Affiliations



AK and VK have conceptualized the study; KG and VE carried out data analysis and interpretation and all the authors were involved in manuscript writing; All authors approve of the manuscript. AK will act as the guarantor for this paper.

Corresponding author

Correspondence to Khadilkar Anuradha.

Ethics declarations

Conflict of Interest


Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anuradha, K., Ketan, G., Vaman, K. et al. Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys. Indian J Pediatr 90, 982–987 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: