Geographic Variation Among Child Malnutrition Correlates in Tamil Nadu: A Multilevel Approach

Maternal and child malnutrition in low-income countries is a major public health challenge in India. Socioeconomic status and maternal health factors are associated with child malnutrition, and it remains under-prioritised. The study aims to quantify geographic variation in maternal, child and household risk factors across villages and districts in Tamil Nadu. The National Family Health Survey (NFHS-5, 2019-2022) dataset was used for analysis. 6373 live children were included. Multilevel logistic regression models were applied, and intraclass correlation coefficients were estimated using null models. The results show that the majority of variation in socioeconomic conditions, maternal health indicators and child health practices is concentrated at the village-level, with minimal variation across districts. The key risk factors include poverty, unimproved sanitation, unsafe child stool disposal, insufficient ANC visits, early marriage, diarrhoea, and pneumonia exhibit strong village-level associations. The micro-level inequalities are masked at the district-level. Household conditions, maternal health, and child healthcare practices are shaped at the village-level.