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Background The increased global discourse on nutrition challenges has underscored the imperative to comprehend and monitor diverse manifestations of malnutrition. The comprehensive monitoring of various forms of malnutrition, including undernutrition, overnutrition, and micronutrient deficiencies, plays a pivotal role in assessing the progress towards the Global Nutrition Targets (GNTs) established by the World Health Assembly (WHA), as well as nutrition-related SDGs (SDGs). To this end, a Composite Index (CI) of six nutrition indicators centred on GNTs has been formulated to gauge and appraise progress across India’s various States and Union Territories (UTs). Methods To calculate the CI, the authors apply a methodology developed by Webb et al. (2015). Disparities in performance between Indian States and UTs are highlighted. The analysis uses data from two surveys: the National Family Health Survey (NFHS) of 2015-16 and the NFHS of 2019-21. The main analytical tool is a rank-order analysis of the CI scores among states and union territories, with higher scores representing greater progress in achieving the targets for the six indicators. Results Based on data from both NFHS-4 and NFHS-5, India’s overall estimated CI-WHA score stood at 2.80 and 2.86, respectively. Notably, the CI-WHA exhibited considerable inter-State/UT variation, ranging from 2.16 in Dadra and Nagar Haveli and Daman and Diu to 5.07 in Manipur, as per NFHS-4, and from 2.14 in Gujarat to 5.25 in Manipur, as per NFHS-5. Among the 34 States/UTs for which complete data sets for all six WHA targets were available from NFHS-4, the top five performers according to the developed CI-WHA targets were Manipur (5.07), Mizoram (4.87), Nagaland (4.12), Kerala (4.00), and Telangana (3.80). In contrast, the bottom five States/UTs based on NFHS-4 data were Dadra and Nagar Haveli and Daman and Diu (2.16), Uttar Pradesh (2.31), Meghalaya (2.40), Haryana (2.40) and Madhya Pradesh (2.43). However, based on NFHS-5 data, the top five States/UTs were Manipur (5.25), Mizoram (4.29), Puducherry (UT) (4.15), Goa (3.89), and Kerala (3.87), while the bottom five were Gujarat (2.14), Tripura (2.16), West Bengal (2.20), Bihar (2.31), and Assam (2.46). Conclusions Applying the CI to monitor States/UTs’ progress in reaching WHA targets. Furthermore, it offers a means to track the progress made on nutrition-related SDGs at the sub-national level. This can help identify States/UTs whose nutrition policies and programs require targeted enhancements to comprehensively improve India’s performance concerning GNTs. It aims to empower policymakers with the information required to make informed decisions and implement effective measures to enhance overall nutrition outcomes, especially in under-performing States/UTs.

Abstract Background The interdisciplinary Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages (PANChSHEEEL) study used a participatory approach to develop locally-feasible and tailored solutions to optimise Infant and Young Child Feeding (IYCF) practices at an individual, household, community, and environmental level. This paper aims to evaluate the influence of gender; migration; and Health, Education, Engineering and Environmental (HEEE) factors on IYCF practices, with the primary outcomes being three key complementary-feeding practices of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD). Methods A cross-sectional survey of 325 households with children aged 6–23 months was conducted in nine purposively selected villages in two blocks of Banswara district, Rajasthan, India. A survey tool was developed, translated into the local language, pre-tested, and administered in a gender-sensitive manner. Data-collection processes were standardized to ensure quality measures. Association of the primary outcome with 27 variables was tested using a Chi-square test (Mantel-Haenszel method); backward stepwise regression analysis was conducted to assess the impact of effect modifiers (gender, parental migration). Results Half of the surveyed children were of each gender, and fathers from half of the households were found to have migrated within the previous year to search for additional income. Parental literacy ranged from 60 to 70%. More than half of the households had access to milk-producing animals. Consumption of each of the seven food groups, eggs (4.7% vs 0.7%; p

Background: Malnutrition is a multifaceted problem requiring interventions that address the multi-sectoral determinants contributing to it. As per National Family Health Survey - 5 (2019-21), with 33.8% stunted, 20.3% wasted, and 32.2% underweight children, West Bengal is one of the high burden states for childhood undernutrition in India. Objectives: The objective of the study was to assess household-level access (i.e. the percentage of households availing select services) to various nutrition-specific and nutrition-sensitive interventions and understand the extent to which convergent action has taken place in the most hard-to-reach areas of the Sundarbans. Methods: Cross-sectional survey following 30 x 30 cluster sampling; the sampling was done based on population proportion to size (PPS) methodology. A total of 912 households were recruited for a quantitative survey, and the data was collected through computer-assisted personal interview (CAPI) tools. Data was collected from October 15-25, 2021 from households having at least one child in the age group of 6 – 24 months. Result: The study focused on 19 nutrition-specific and sensitive interventions. Household-level coverage of 13 of these interventions was 1.5%; coverage of the six others was 4.2%. The estimated coverage of all 19 interventions was found to be almost non-existent (0.2%). Conclusion: The conspicuously low coverage of services at the household level is a clear indicator of poor convergence of government schemes and programs, reflecting, in turn, disjointed action on the part of the various departments of the government. The results suggest the need for reconsidering the household-level delivery of services as a wholesome package of interventions rather than seeing them as discrete departmental deliverables.

Background: India bears a disproportionate burden of undernutrition. Access to an affordable, nutritious diet is one of the critical challenges. There is a need to assess the cost of a nutritious diet and find ways to understand and minimise the affordability gap through a comprehensive approach. Objective: The present study was conducted in the West Singhbhum district of Jharkhand, India. Its objective was to find out the cost of various diets, and their affordability, based on households’ accounting for their total food expenditure, and assessing the coverage of essential governments’ nutrition-specific interventions to use a model for suggesting ways to minimise the affordability gap. We also estimate the potential impact of nutrition-sensitive programmes on household food affordability. Methodology: The study employed the Cost of the Diet (CotD) methodology, a mixed-method, cross-sectional assessment, where the research team conducted surveys in 16 markets, 12 focus group discussions (FGDs) and 96 individual interviews (IDIs). Additionally, 434 household-level surveys were conducted to understand income, expenditure patterns in the localities and uptake of key nutrition-sensitive interventions. Secondary information from the 68th round of the National Sample Survey 2012 were used to assess rural Jharkhand’s non-food expenditure (NFE). Data were analysed primarily using the Save the Children’s Cost of the Diet software version 2.5.2. Results: The cost of the diet increased with an increase in the diet quality – from a basic energy-only diet costing INR 33,892 ($505.85)[1] per year for a standard household with 6 members to a food-habit nutritious diet (FHAB) costing INR 70,627 ($1054.13) per year. More than half of the sampled households could not afford a nutritious diet. The poorest quartile was spending 56.8% of income on food, compared to 33.7% for the richest quintile. Conclusion: The cost of a FHAB diet should be used as a benchmark to track the progress of beneficiary groups in upcoming socio-economic assessments. Changes in the affordability gap should be observed to assess whether new initiatives have worked. Optimal coverage of existing nutrition-specific and nutrition-sensitive programmes has the potential to reduce the cost of a FHAB nutritious diet by up to 30%. [1] $1=INR 67 (The exchange rate at the time of data collection, December 2019)