Front Public Health. 2026 Aug 3;14:1854301. doi: 10.3389/fpubh.2026.1854301. eCollection 2026.
ABSTRACT
INTRODUCTION: Childhood stunting remains a critical indicator of chronic undernutrition and a major barrier to achieving Sustainable Development Goals 1 and 2. Despite gradual improvements, substantial geographic disparities in stunting risk persist across India. This study characterised the spatial and temporal heterogeneity of childhood stunting using harmonized district-level data from NFHS-4 (2015-16) and NFHS-5 (2019-21).
METHODS: A Bayesian spatial geo-additive logistic regression model was applied to 482,960 children aged 0-59 months from 575 harmonized districts. The framework incorporated district-level BYM2 spatial random effects, district-specific survey-round interaction effects, and RW2 smoothers for child age and maternal BMI, estimated using Integrated Nested Laplace Approximation (INLA).
RESULTS: The spatial interaction model demonstrated substantially improved fit over the non-spatial model (ΔWAIC = 4,105.2), with a high estimated spatial fraction (φ = 0.983; 95% CrI: 0.938-0.999), indicating that most residual district-level variation was spatially structured. Model predictions showed strong agreement with weighted survey prevalence estimates (Pearson r = 0.975; R 2 = 0.950). After accounting for district-specific temporal interactions, there was no evidence of a uniform national change in stunting risk between survey rounds (AOR = 0.986; 95% CrI: 0.960-1.013), with substantial heterogeneity in district-level temporal trajectories. Stunting risk peaked between 18 and 24 months of age and was elevated among children of severely undernourished mothers. Based on 95% posterior credible intervals of district-specific survey-round interaction effects, 59 districts demonstrated credible improvement, 35 demonstrated credible worsening, and 481 showed no credible evidence of change. A joint dOR-prevalence framework identified 213 districts (37.0%) as highest-priority areas, combining elevated adjusted district-level risk with high absolute stunting burden.
DISCUSSION: These findings demonstrate that childhood stunting in India remains strongly patterned by geography, with temporal changes varying substantially across districts. Geographically targeted and maternal-focused interventions will be essential for achieving equitable reductions in stunting and accelerating progress toward national nutrition goals.
PMID:42609395 | PMC:PMC13478098 | DOI:10.3389/fpubh.2026.1854301
