Ecological and social patterns of child dietary diversity in India: a population-based study

Dietary diversity (DD) measures dietary variation in children. Factors
at the child, community, and state levels may be associated with poor
child nutritional outcomes. However, few studies have examined the role
of macro-level factors on child DD. This study seeks to 1) describe the
distribution of child DD in India, 2) examine the variation in DD attributable
to the child, community and state levels, and 3) explore the relationship
between community socioeconomic context and child DD. Using nationally
representative data from children aged 6-23 months in India, multilevel
models were used to determine the associations between child DD and
individual- and community-level factors. There was substantial variation in
child DD score across demographic and socioeconomic characteristics. In an
age and sex-only adjusted regression model, the largest portion of variation
in child DD was attributable to the child level (75%) while the portions of
variance attributable to the community-level and state level were similar to
each other (15% and 11%). Including individual-level socioeconomic factors
explained 35.6 percent of the total variation attributed to child DD at the
community level and 24.8 percent of the total variation attributed to child
DD at the state level. Finally, measures of community disadvantage were
associated with child DD in when added to the fully adjusted model. This
study suggests that both individual and contextual factors are associated with
child DD. These results suggest that a population-based approach combined
with a targeted intervention for at-risk children may be needed to improve
child DD in India.