No time to waste for wasted children in Bihar: time to reset


  • Kumar Saurabh Program for Appropriate Technology in Health (PATH), Nutrition, Family Health, PATH, New Delhi, India
  • A. K. Jaiswal Department of Pediatrics, Patna Medical College and Hospital (PMCH), Patna, Bihar, India
  • A. K. Tiwari Department of Pediatrics, Patna Medical College and Hospital (PMCH), Patna, Bihar, India



Wasting, Severe wasting, Under-nutrition, Severe acute malnutrition, Malnutrition, NFHS


Background: Severe acute malnutrition (SAM) with severe wasting remains a major killer of children. In Bihar, 48% of children are stunted, 21 % are wasted, and 7% are severely wasted. Even during the first six months of life, 31% are wasted. The objective of this study was to study wasting trends and contributing factors responsible for changes in Bihar among children 0-5 years.  

Methods: This cross-sectional study was done using a data of NFHS-5 survey in Bihar (N=35,834) conducted in all 38 districts of the state from July, 2019 to February, 2020. The Bihar NFHS-5 report and factsheets, including NFHS-4 data, were downloaded and converted to excel to enable data visualization and trend analysis. The outcome variable Wasting was measured using NFHS-5 relevant questionnaires given under nutrition category. We analyzed trends between NFHS-5 and NFHS-4 Bihar data for severe wasting/wasting, determinants, and coverage of interventions.

Results: The prevalence of severe wasting has increased from 7% to 8.8%, while wasting increased from 20.8% to 22.9% (NFHS-5). The severe wasting and wasting has reversed or worsened in 27 districts. There is a mixed picture of infant feeding- early initiation of breastfeeding worsening and some improvements in exclusive breastfeeding and timely introduction of complementary feeding. Consistent improvement across districts for underlying determinants, but slight, in women’s education, teenage pregnancy, and marriage before 18 years.  

Conclusions: Need to invest in improving maternal determinants-age at marriage, education, ANC coverage, and teenage pregnancy. It is imperative to focus on preventing, identifying, and treating wasting.


IIPS Mumbai, National family health survey (NFHS-5). Government of India: Ministry of Health and Family Welfare, 2020. Available at: Accessed on 11 July 2022.

Ministry of Health and Family Welfare, Government of India. Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition, 2011. Available at: http://rajswasthya. Accessed on 03 July 2022.

UNICEF. Conceptual framework on maternal and child nutrition, 2020. Available at: Accessed on 13 July 2022.

Benelam B, Wyness L. Hydration and health: a review. Nutr Bull. 2010;35(1):3-25.

Islam SN, Kamal MM, Rahmatullah R, Sadi SKS, Ahsan M. Serum zinc levels in children with acute respiratory infections: Association with socio demography and nutritional status. Clin Nutr Exp. 2018;22:11-8.

Barker M, Dombrowski SU, Colbourn T, Fall CH, Kriznik NM, Lawrence WT, et al. Intervention strategies to improve nutrition and health behaviours before conception. The Lancet 2018;391(10132):1853-64.

Dhaded SM, Hambidge KM, Ali SA, Somannavar M, Saleem S, Pasha O, et al. Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial. PLoS One. 2020;15(1):e0218960.

Hurley K, Achadi EL, Ajello C, Askari S, Bajoria M, Beesabathuni K, et al. Prevention of child wasting in Asia: Possible role for multiple micronutrient supplementation in pregnancy. Field Exch. 2020;63:76.

Harding KL, Aguayo VM, Webb P. Factors associated with wasting among children under five years old in South Asia: Implications for action. PLoS One. 2018;13(7):e0198749.

Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, et al. Reproductive health, and child health and nutrition in India: meeting the challenge. Lancet. 2011;377(9762):332-49.

Ali Z, Saaka M, Adams AG, Kamwininaang SK, Abizari AR. The effect of maternal and child factors on stunting, wasting and underweight among preschool children in Northern Ghana. BMC Nutr. 2017;3:31.

Schoenbuchner SM, Dolan C, Mwangome M, Hall A, Richard SA, Wells JC, et al. The relationship between wasting and stunting: a retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016. Am J Clin Nutr. 2019;110(2):498-507.

Panjwani A, Heidkamp R. Complementary Feeding Interventions Have a Small but Significant Impact on Linear and Ponderal Growth of Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. J Nutr. 2017;147(11):2169S-78S.

Briaux J, Fortin S, Kameli Y, Agboka Y, Romedenne M, Boko J, et al. Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo. Matern Child Nutr. 2019;15(4):e12843.

Mishra K, Kumar P, Basu S, Rai K, Aneja S. Risk factors for severe acute malnutrition in children below 5 y of age in India: a case-control study. Indian J Pediatr. 2014;81(8):762-5.

Raaijmakers A, Allegaert K. Catch-up growth in former preterm neonates: no time to waste. Nutrients. 2016;8(12):817.

Rahman M. Association between order of birth and chronic malnutrition of children: a study of nationally representative Bangladeshi sample. Cadernos de Saude Pub. 2016;32.

Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under‐five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. Int J Gynecol Obstetr. 2005;89:S7-S24.






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