Introduction: Malnutrition among adolescents is a persistent problem with a profound impact on different dimensions of health. The objective of this analysis is to assess the burden of malnutrition (Stunting, Thinness, Overweight, and Obesity) and their associated socio-demographic factors among Indian adolescents (10–19 years) from the Comprehensive National Nutritional Survey (CNNS 2016-18) data. Methods: We used Individual-level data of 35,831 adolescents from the CNNS conducted in 2016–18 for this analysis. CNNS collected data on the nutritional status of adolescents along with socio-demographic variables from all states of India. Burden of stunting (Height for age Z score, HAZ < −2 SD), thinness (BMI for age Z score, BAZ < −2 SD), overweight (BAZ > 1 SD) and obesity (BAZ > 2 SD) were estimated for the entire country and individual states. A multivariable logistic regression analysis was used to assess the socio-demographic factors associated with stunting, thinness, and overweight. Results: CNNS collected data from 35,831 adolescents, of which 31,941 with BAZ scores, and 32,045 with HAZ scores were included in the final analysis. The burden of stunting and thinness among Indian adolescents was 27.4% (95% CI 26.4, 28.4%) and 24.4% (23.5, 25.4%), respectively. The burden of overweight and obesity was 4.8% (4.5, 5.1%) and 1.1% (0.9, 1.3%), respectively. Adolescents in the age group of 15–19 years (AOR 1.23, 95% CI 1.11, 1.36) compared to 10–14 years, females (AOR 1.20; 1.08, 1.33) compared to males, were at increased odds of getting stunted. Adolescents from lowest wealth index families (AOR 1.66; 1.33, 2.07) were at increased odds of thinness compared to peers of higher wealth index families. Adolescents of 10–14 years (AOR 1.26, 95% CI 1.06, 1.49) compared to 15–19 years, urban residents (AOR 1.43, 95% CI 1.19, 1.71) compared to rural residents, were at increased odds of overweight. Conclusion: Indian adolescents face the double burden of malnutrition that is undernutrition (stunting and thinness) alongside overnutrition (overweight and obesity) that are linked with socio-demographic factors. The National Nutritional Programs (POSHAN Abhiyan) should prioritize high-risk groups specifically older age group (15–19 years), females, and low wealth Index quintile families identified in this analysis.

Introduction Rotavirus infection accounts for 39% of under-five diarrhoeal deaths globally and 22% of these deaths occur in India. Introduction of rotavirus vaccine in a national immunisation programme is considered to be the most effective intervention in preventing severe rotavirus disease. In 2016, India introduced an indigenous rotavirus vaccine (Rotavac) into the Universal Immunisation Programme in a phased manner. This paper describes the protocol for surveillance to monitor the performance of rotavirus vaccine following its introduction into the routine childhood immunisation programme. Methods An active surveillance system was established to identify acute gastroenteritis cases among children less than 5 years of age. For all children enrolled at sentinel sites, case reporting forms are completed and a copy of vaccination record and a stool specimen obtained. The forms and specimens are sent to the referral laboratory for data entry, analysis, testing and storage. Data from sentinel sites in states that have introduced rotavirus vaccine into their routine immunisation schedule will be used to determine rotavirus vaccine impact and effectiveness. Ethics and dissemination The Institutional Review Board of Christian Medical College, Vellore, and all the site institutional ethics committees approved the project. Results will be disseminated in peer-reviewed journals and with stakeholders of the universal immunisation programme in India.

Exclusive breastfeeding is recommended in the first six months of life. Observing breastfeeding practices and further the introduction of complementary food using a birth cohort can provide a better understanding with reference to the child’s growth and nutrition. We aim to describe the exclusive breastfeeding practices in the Indian MAL-ED birth cohort. The Indian MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort comprises of eight contiguous urban slums in Vellore. Of the 251 children enrolled in the cohort at birth, a 24 month follow-up was completed for 228 children and data collection was from March 2010 through February 2012. Trained field research assistants collected data on exclusive breastfeeding and complementary feeding practices from birth using a structured questionnaire through a biweekly surveillance. Survival and Cox proportional hazard regression analyses were used to estimate the duration of exclusive breastfeeding and factors influencing the same. Breastfeeding was initiated within the first hour of birth in 148 (59%) infants. Colostrum was given in 225 (89.6%) infants whilst 32 (12.7%) infants received prelacteal feeds. Exclusive breastfeeding up to four months was observed in 55 (22.1%, 95% Confidence Interval [CI] 17.1%, 27.5%) infants with only three (1.1%, 95% CI 0.2%, 3.5%) of the cohort mothers continuing to exclusively breastfeed up to six months. Cox proportional hazard regression analysis revealed no gender differences to being exclusive breastfed (Adjusted Hazard Ratio [AHR] 0.97; 95% CI 0.74, 1.27). Children from families of low socioeconomic status had a lower risk of early cessation of exclusive breastfeeding compared to children from middle or higher socioeconomic status (AHR 0.52; 95% CI 0.38, 0.71). Early initiation of exclusive breastfeeding is important and improving rates suggest continuation of efforts in this direction energetically. Continuation of exclusive breastfeeding practice is significantly low in these urban slums with introduction of animal milk and complementary foods even before six months of age. This highlights the urgent need to evaluate pragmatic interventions to raise awareness on the importance of exclusive breastfeeding and its practice.

Malnutrition includes both under-nutrition and over-nutrition, which have negative health impacts and social consequences. The present study aims to understand the demographic dynamics, burden of chronic illnesses, and risk factors associated with malnutrition (stunting, thinness, and obesity) among different age groups in urban and rural areas. Data were collected through a cross-sectional study conducted in an urban area in Hyderabad and four rural villages in Andhra Pradesh. A multivariable mixed-effect logistic regression was used to assess the risk factors associated with malnutrition among different age groups. The final analysis included the data of 10,350 individuals, consisting of 8317 (80.4%) from urban areas and 2033 (19.6%) from rural areas. The number of known cases of hypertension in the urban area was 926 (11.1%) and 114 (5.6%) in the rural areas, and that of diabetes was 511 (6.1%) in the urban area and 104 (5.1%) in the rural areas. The burden of stunting among under-five children and obesity among adults was 33.7% (95% CI; 29.7–37.9) and 47.4% (95% CI; 45.8–49.1), respectively. Adults aged 40–59 years (AOR 1.91; 1.59–2.28) and belonging to a clerical/skilled (AOR 1.32; 1.03–1.71) occupation were at higher odds of obesity compared to their counterparts. Policymakers and health practitioners should consider the insights from our findings to tailor effective interventions to address malnutrition.

Introduction: Composite Index of Anthropometric Failure (CIAF) and its further modifications have not incorporated all the combinations of malnutrition. We propose a new model incorporating all the forms of malnutrition among children under five years of age. However, the current models might misclassify a growing child as malnourished. Our objective is to develop a comprehensive scoring system using the three anthropometric Z-scores [height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) Z-scores] and demonstrate the proposed CIAF model using the National Family Health Survey-5 (NFHS-5) data from India.Methods: A new scoring system was developed using the WAZ, HAZ, and WHZ scores to determine the child’s nutritional status. We also proposed a new CIAF model by including all possible categories of malnutrition and practically demonstrated it using the NFHS-5 dataset after applying the new scoring system. Under-five children with heights, weights, and ages available were included in the analysis. The groups of malnutrition are presented as weighted proportions before and after applying the new score to the proposed model.Results: Our final analysis included individual-level data of 198,802 children under five years of age (weighted N = 195,197). After applying the new scoring system to the proposed model, the prevalence of stunting has reduced to 11.8% (95% CI 11.66–11.94) from 13.2% (95% CI 13.09–13.39) and wasting prevalence has reduced to 4.9% (95% CI 4.85–5.04) from 6.4% (95% CI 6.29–6.51). The most common forms of anthropometric failures among Indian children by using the newly developed CIAF model are: “Stunting and underweight” (30,127; 15.4%), Stunting only (23,035; 11.8%), and “wasting and underweight” (14,698; 7.5%). We found a new category called “Stunting, underweight, and overweight” (stunting = HAZ < −2SD, underweight = WAZ < −2SD, overweight = WHZ > +2SD). It constituted 0.1% (220 children) of the total sample.Conclusion: When the new scoring system is applied to the proposed CIAF model, it captures all forms and combinations of malnutrition among under-five children without overlap and prevents misclassifying a growing child as malnourished. The newly identified category shows that stunting (HAZ < −2SD), overweight (WHZ > +2SD) and underweight (WAZ < −2SD) can co-exist in the same child.

Food fortification with micronutrients is one of the cost-effective and sustainable methods to prevent micronutrient deficiencies at community level. The rice fortified with iron, folic acid, and vitamin B12 is being supplied through various social welfare schemes in India in a phased manner and planned to cover the entire country by March 2024. We have conducted a situational analysis to assess the rollout of fortified rice supplied through the Public Distribution System (PDS) and to evaluate the accessibility, availability, acceptability, and utilization of fortified rice by the beneficiaries of the PDS. This was a mixed-method, sequential exploratory study conducted in six districts from six different states of India that had begun distribution of fortified rice through PDS in pilot mode during 2020–2021. In each district, the district supply officer of the PDS, Food Corporation of India (FCI) or State Food Corporation (SFC) warehouse supervisor, and four Fair Price Shop (FPS) dealers were interviewed. Under each FPS, a minimum of seven beneficiary households were randomly selected and interviewed using a structured questionnaire. The in-depth interviews were conducted with different stakeholders using theme guides. All the interviewed stakeholders were aware about their roles and responsibilities and purpose to distribute fortified rice. There was a continuous supply of fortified rice (across all visited districts) to beneficiaries through a well-established system. Acceptability and compliance to intake of fortified rice was good with no reported gastrointestinal adverse outcomes following fortified rice intake. There was an efficient roll-out of fortified rice though PDS with a good compliance to intake of fortified rice. It is feasible to design and conduct a study to assess the impact of fortified rice on anemia and iron storage at the community level.