title: Is economic growth associated with reduction in child undernutrition in India?
abstract: BACKGROUND
  Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India.
  
  
  RESULTS
  Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992-93, 1998-99, and 2005-06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%-20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization-determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes.
  
  
  CONCLUSIONS
  We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India. Please see later in the article for the Editors' Summary.
authors.affiliation: Center for Integrative Approaches to Health Disparities, School of Public Health, University of Michigan, Ann Arbor, MI, USA. svsubram@hsph.harvard.edu
authors.forename: Malavika A
authors.initials: MA
authors.lastname: Subramanyam
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D001827:Body Height; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D057217:Economic Development; D005260:Female; D059066:Gross Domestic Product; D006130:Growth Disorders / Q000191:economics / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D007182:Income; D007194:India; D007223:Infant; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D009752:Nutritional Status; D015995:Prevalence; D012307:Risk Factors; D013851:Thinness / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D019282:Wasting Syndrome / Q000191:economics / Q000453:epidemiology*