Understanding the Spatial Predictors of Malnutrition Among 0–2 Years Children in India Using Path Analysis

Background: India ranks 102 of 117 countries on the Global Hunger Index, indicating a serious hunger situation. Targeted interventions require identifying key determinants directly or indirectly influencing child malnutrition. Methods: Using NFHS-4 (2015–16) data, the authors developed a structural equation model (path analysis) to estimate direct, indirect, and total effects of determinants on stunting, wasting, and underweight among children aged 0–24 months. Exploratory spatial analysis identified local clusters (hotspots) of critical factors (low birth weight, diarrhea, water source, toilet facility, prenatal visits, exclusive breastfeeding). Analyses used STATA 15.1MP and GeoDa 1.14 with significance at p<0.05. Results: The analytical sample included 90,842 children. Model fit was good (CFI=0.980; TLI=0.927; RMSEA=0.036; p-close=1). Global Moran’s I indicated spatial clustering for diarrhea (0.446), poor drinking water source (0.638), no exclusive breastfeeding (0.345), low birth weight (0.439), no prenatal visits (0.620), and poor toilet facility (0.727). Hotspots identified: diarrhea (77), poor drinking water (102), no exclusive breastfeeding (63), low birth weight (88), no prenatal visits (81), poor toilet facility (160). Direct effects: diarrhea and exclusive breastfeeding were robustly associated with wasting, underweight, and stunting; number of children ever born positively associated with all three; higher birth weight, maternal BMI, maternal education, and household wealth were protective. Indirect effects involved maternal education, residence, and desired pregnancy. Conclusion: Diarrhea, exclusive breastfeeding, and parity showed strong direct associations with child stunting, wasting, and underweight, while maternal education, residence, and pregnancy intention influenced outcomes indirectly. Spatial hotspots can guide geographically tailored interventions. Strengthening interventions during the first 1,000 days is critical to curb growth faltering.