title: Undernutrition among adults in India: the significance of individual-level and contextual factors impacting on the likelihood of underweight across sub-populations.
abstract: To investigate the extent to which individual-level as well as macro-level contextual factors influence the likelihood of underweight across adult sub-populations in India.
  
  
  
  Population-based cross-sectional survey included in India's National Health Family Survey conducted in 2005-06. We disaggregated into eight sub-populations.
  
  
  
  Multistage nationally representative household survey covering 99 % of India's population.
  
  
  
  The survey covered 124 385 females aged 15-49 years and 74 369 males aged 15-54 years.
  
  
  
  A social gradient in underweight exists in India. Even after allowing for wealth status, differences in the predicted probability of underweight persisted based upon rurality, age/maturity and gender. We found individual-level education lowered the likelihood of underweight for males, but no statistical association for females. Paradoxically, rural young (15-24 years) females from more educated villages had a higher likelihood of underweight relative to those in less educated villages; but for rural mature (>24 years) females the opposite was the case. Christians had a significantly lower likelihood of underweight relative to other socio-religious groups (OR=0·53-0·80). Higher state-level inequality increased the likelihood of underweight across most population groups, while neighbourhood inequality exhibited a similar relationship for the rural young population subgroups only. Individual states/neighbourhoods accounted for 5-9 % of the variation in the prediction of underweight. We found that rural young females represent a particularly highly vulnerable sub-population.
  
  
  
  Economic growth alone is unlikely to reduce the burden of malnutrition in India; accordingly, policy makers need to address the broader social determinants that contribute to higher underweight prevalence in specific demographic subgroups.
authors: 1Crawford School of Public Policy,Australian National University,Canberra,Australia.
authors: Md Zakaria
authors: MZ
authors: Siddiqui
authors: 3UniSA Business School,University of South Australia,Way Lee Building,City West Campus,37-44 North Terrace,Adelaide,SA 5001,Australia.
authors: Ronald
authors: R
authors: Donato
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012067:Religion; D012424:Rural Population; D012959:Socioeconomic Factors; D013851:Thinness / Q000453:epidemiology*; D055815:Young Adult
keywords: Contextual factors; India; Sub-populations; Underweight