Variation in human growth and the genetic and environmental factors that are influencing it have been described worldwide. The objective of this study is to assess the geographical variance of under-five nutritional status and its related covariates across Indian districts. We use the most recent fourth round of the Indian National Family Health Survey conducted in 2015–2016, which for the first time offers district level information. We employ principal component analysis (PCA) on the demographic and socio-economic determinants of childhood morbidity and conduct hierarchical clustering analysis to identify geographical patterns in nutritional status at the district level. Our results reveal strong geographical clustering among the districts of India, often crossing state borders. Throughout most of Southern India, children are provided with relatively better conditions for growth and improved nutritional status, as compared to districts in the central, particularly rural parts of India along the so called “tribal belt”. Here is also where girls are on average measured to have less weight and height compared to boys. Looking at average weight, as well as the proportion of children that suffer from underweight and wasting, north-eastern Indian districts offer living conditions more conducive to healthy child development. The geographical clustering of malnutrition, as well as below-average child height and weight coincides with high poverty, low female education, lower BMI among mothers, higher prevalence of both parity 4 + and teenage pregnancies. The present study highlights the importance of combining PCA and cluster analysis in studying variation in under-five child growth and of conducting this analysis at the district level. We identify the geographical areas, where children are under severe risk of undernutrition, stunting and wasting and contribute to formulating policies to improve child nutrition in India.

中文翻译：

---

五岁以下儿童的生长和营养状况：印度地区的空间聚集

全世界已经描述了人类生长的变化以及影响人类生长的遗传和环境因素。这项研究的目的是评估印度各地区五岁以下儿童营养状况及其相关协变量的地理差异。我们使用2015年至2016年进行的印度全国家庭健康调查的最新第四轮调查，该调查首次提供了地区级别的信息。我们对儿童发病率的人口和社会经济决定因素采用主成分分析（PCA），并进行层次聚类分析，以识别区级营养状况的地理格局。我们的结果表明，印度各地区之间经常跨越国家边界，形成了强大的地理集群。在印度南部大部分地区，与印度中部地区，特别是所谓的“部落带”沿线的农村地区相比，为儿童提供了相对更好的成长条件和改善的营养状况。这也是女孩平均体重和身高低于男孩的地方。从平均体重以及体重不足和消瘦的儿童比例来看，印度东北部地区提供的生活条件更有利于儿童健康成长。营养不良的地理分布以及儿童身高和体重均低于平均水平，这与高贫困，女性教育程度低，母亲的BMI较低，4岁及以上的同龄人和青少年怀孕的发生率相吻合。本研究强调了结合PCA和聚类分析在研究5岁以下儿童成长中的差异以及在地区一级进行此分析的重要性。我们确定了儿童严重营养不足，发育迟缓和浪费的地理区域，并为制定改善印度儿童营养的政策做出了贡献。