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Cross-sectional study of child malnutrition and associated risk factors among children aged under five in West Bengal, India

whereas wasting indicates acute or recent growth disturbance. The results obtained in the present
study indicate a significant age differential in the prevalence of underweight status, stunting, and
wasting among children. Underweight status was the highest (56%) in the ‘24−35 months’ age group
and the lowest among children aged 12−23 mo nths. On the other hand, stunting was inversely asso-
ciated with child’s age, while the association with wasting was positive.Similar associations ha-
ve been reported in other studies conducted in India (Bharti, Chakrabarty, Som et al., 2010; Kamiya,
2011).
In contrast to the findings reported by other authors (Dasgupta, 1987; Habyarimana, Zewotir and
Ramroop, 2014; Payandeh, Saki, Safarian et al., 2013), the present study failed to reveal any signif-
icant gender and religion differentials in the prevalence of underweight status, stunting, and wasting
among children. Nonetheless, we observed clear gender discrimination in nutritional status, which
increases with the child’s age. While no gender differences were found in the lowest age group
(6−23 months), the gender gap in the prevalence of these three nutritional indices widened as chil-
dren matured (24−59 months). We found similar gender patterns for stunting as well as wasting. Our
findings strengthen the argument that the gender-related difference in malnutrition found in young-
er children is a biological phenomenon rather than a social one. Biologically, female children are
stronger than male children, and are found to be more resistant to infectious agents (Gangadharan
and Maitra, 2000; Hill and Upchurch, 1995; Singh, Hazra and Ram, 2007), which is why
female children are less malnourished than their male counterparts in the lower age group, when
gender discrimination is supposed to be absent. At younger ages, children are heavily dependent
on breast milk for their nutrition and are thus unlikely to be competing with other family members
for food resources (Griffith, Matthews and Hinde, 2002). Consequently, due to their adequate nutri-
tion and biological advantage, very young female children remain healthier relative to their
male counterparts. However, gender discrimination starts to play a significant role once the child is
no longer breastfed and has to compete for a share of family resources (Griffith, Matthews and
Hinde, 2002). Thus, while gender discrimination is absent in infancy, it gradually emerges in child-
hood because of social discrimination, rather than biological factors. Female children experience
multifaceted discrimination, including lack of adequate nutrition, inappropriate healthcare practices,
and inconsistent treatment seeking, among others, causing numerous health consequences, such as
malnutrition, illness, morbidity, and mortality (Dasgupta, 1987; Kishor, 1993; Miller, 1981; Sen,
1988). The higher prevalence of malnutrition among female children observed in the older ages in
this study indicates that female children become victims of greater gender discrimination as they
mature, when their biological advantage diminishes.
Multivariate analyses revealed that religion and caste play an important role in determining child
malnutrition. Muslim children were more likely to be underweight compared to Hindu children.
Similarly, scheduled caste children were more likely to be malnourished compared to general ca-
ste children. Religion and caste are important means of social stratification in India. Cultural activi-
ties, rituals and practices are determined by religion and caste stratification. In terms of caste, SC is a
more disadvantaged group compared to the general caste and faces discrimination in accessing many
services, such as income, education, hygiene, sanitation, and public health utilization. Existing re-
search has revealed that Muslim and SC children are more vulnerable compared to Hindu and gen-
eral caste children, respectively, due to inadequate immunization, lack of nutrient-rich diet, inappro-
priate hygiene and sanitation, etc. (Kumar and Mohanty, 2011; Sabharwal, 2011). Utilization of an-
tenatal care and nutritional status among Muslim and SC women is also found to be poor compared
to Hindu and general caste women, which adversely affects children’s nutritional outcomes. Perhaps
higher malnourishment among Muslims and SC children is due to the differentials in childcare prac-
tices, poor utilization of healthcare services and inadequate child feeding behavior.
The study revealed that more than half of the children experienced stunted growth. It may be the
result of long-term interactions of a complex set of factors like inadequate nutrition, poor feeding

98 International Journal of Population Studies | 2016, Volume 2, Issue 1