Research

Publications

Kumar, Mukesh (2024). Caste and class interactions in inequality in access to sanitation and hygiene services in India

Journal of Water Sanitation and Hygiene for Development, Vol. 14, No. 5. (with Suman Kharb)

Given moderate access to WASH services at the national level, widespread socio-economic inequality still exists in India. This study assesses the status of access to different types of sanitation and hygiene services in India and how the caste and class interactions are associated with them. We use nationally representative household survey data and the Joint Monitoring Programme (JMP) sanitation and hygiene framework. For descriptive analysis, frequency distribution is used. Multivariable logistic regression is applied, and caste interactions are used to estimate the probabilities. Overall, 51.2 and 71.8% of the households have access to safe sanitation and hygiene services. However, among the Scheduled Tribe households, only 36.6 and 58.7% have access to safe sanitation and hygiene. Findings show that class and caste interactions are strongly associated with WASH services. The probability of access to safe sanitation and hygiene is 16 and 15% points lower for the poorest Scheduled Tribes and Scheduled Castes compared to ‘Other’ socially privileged but economically poor, after adjusting for other household sociodemographic characteristics. The finding suggests that an upscaling of the existing policies and programs alongside considering the caste and class intersectionality is required for equitable access to sanitation and hygiene services and to achieve SDG-6.

Kumar, Mukesh (2023). Undernutrition and anaemia among Indian adolescents: role of dietary diversity and hygiene practices

Journal of Nutritional Science, Vol. 12, No. E33. (with P. C. Mohanty) 

IGIDR Mumbai conference (presentation)

In 2021, the Lancet Commission on adolescent nutrition highlighted the need to prioritise the elimination of adolescent malnutrition to tap the human capital potential and break the intergenerational malnutrition trap. The nutritional requirement during adolescence reaches its peak. The present study aims to appraise the prevalence of undernutrition (stunting and thinness) and anaemia among adolescents (10-19 years) in India and the role of socioeconomic, individual-level hygiene behaviour, and dietary diversity in nutritional outcomes. We have used the nationally representative Comprehensive National Nutrition Survey (CNNS-2016-18) that covers children and adolescents (0-19 years) in India. The prevalence of stunting, anaemia, and thinness among adolescents was 27.2%, 28.5%, and 24.1%, respectively. Bivariate and multivariable logistic regression models were applied to estimate the likelihood of undernutrition. The likelihood of stunting was higher for late adolescence (OR: 1.21, 95 %; CI: 1.15, 1.27), low dietary diversity (OR: 1.37, 95 %; CI: 1.26, 1.49), and low hygiene behaviour compliance (OR: 1.53, 95 %; CI: 1.42, 1.64). Adolescents from the poorest quintile were more likely to be stunted (OR: 3.20, 95 %; CI: 2.94, 3.48), anaemic (OR: 1.66, 95 %; CI: 1.47, 1.87), and thin (OR: 1.68, 95 %; CI: 1.54, 1.82). We found that lower hygienic compliance was significantly associated with undernutrition and anaemia. Therefore, promoting hygienic practices should be emphasised to tackle undernutrition and anaemia. Further, dietary diversity and poverty were strong predictors of stunting and thinness, therefore targeting the poor and focusing on improving dietary diversity should be the priority.

Kumar, Mukesh (2022). Does maternal overnutrition carry child undernutrition in India?

PLoS ONE, Vol. 17, No. 6. (with P. C. Mohanty)

Studies in low-and middle-income countries where nutrition transition is underway provides mixed evidence of double burden of maternal overnutrition and child undernutrition among mother-child pairs. Shifting dietary pattern and rapid increase in overweight/obesity among adults with persistent child undernutrition indicate that India is experiencing nutrition transition and double burden of malnutrition. Hence, the study explores the presence of and the factors associated with mother-child dyads of over- and undernutrition in India.  The study uses National Family Health Survey 2015–16 data. The analytic sample consists of 28,817 weighted mother-child pairs where an overweight/obese mother is paired with an undernourished child. The nutritional status of children is defined according to WHO 2006 child growth standards as underweight (i.e., low weight-for-age), stunting (i.e., low height-for-age) and wasting (i.e., low weight-for-height). Maternal overweight/obesity (i.e., BMI ≥ 25 kg/m2) is defined using adult BMI criterion. Descriptive, bivariate, and adjusted multivariable logistic regression analysis are conducted. Of the overweight/obese mothers, 21.3%, 26.5%, and 14% have underweight, stunted, and wasted children respectively. In adjusted models, maternal short stature (aOR: 2.94, 95% CI: 2.30–3.75), age of child (aOR: 3.29, 95% CI: 2.76–3.92), and poorest wealth status (aOR: 2.01, 95% CI: 1.59–2.54) are significant predictors of overweight/obese mothers and stunted child pairs. Similarly, poor wealth status (aOR: 1.68, 95% CI:1.32–2.14), maternal stature (aOR: 2.70, 95% CI: 2.08–3.52), and child aged 2–5 years (aOR: 1.77, 95% CI:1.51–2.08) are also significantly associated with higher occurrence of overweight/obese mother and-underweight child pairs. Findings of the study are consistent with the phase of nutrition transition and double burden of malnutrition. The paper concludes with suggestions to improve the socioeconomic condition, more strategic nutrition specific investments and policy interventions to eliminate all forms of malnutrition for achieving SDGs.

Kumar, Mukesh. (2022). Decoding the Three Pandemic Budgets: Education, Health, and Nutrition, 

Economic and Political Weekly, Vol. 57, No. 21. (with P. C. Mohanty)

Media: (Daily Pioneer)

Despite substantial socioeconomic disparities in health, education, and nutrition outcomes, the government is pitching human development expenditure against capital expenditure. In a welfare state, social sector should be the centre of policy prescriptions. Instead of an imperfect assumption of trickle-down, the government needs to realise that growth and development must go hand in hand.

Kumar, Mukesh. (2021). COVID-19: A Prospective Analysis of the Implications of School Closure on Children's Education and Nutrition

CHILDREN FIRST Journal On Children's Lives, Vol. 1, No. 1.  (with P. C. Mohanty)

Media: (Daily Pioneer)

The COVID-19 led health crisis has catastrophic implications on people's life irrespective of  their age. The pandemic-induced school closure has made children more vulnerable to the crisis. In India, school closure has a direct bearing on children's rights to education and nutrition because, besides learning, schools have been the regular source of food/nutrition  for children belonging to different sections and especially the marginalised groups. Therefore, this study attempts to analyse the implications of adopting online education—which has exposed the persisting digital divide—and school closure on  children's rights to education and nutrition. The study uses a nationally representative household survey that collected information on access to digital infrastructure and utilization of Mid-Day Meal (MDM) Scheme and the Integrated Child Development Scheme (ICDS) by children. We find a striking digital divide between rural-urban areas and among different socio-religious and economic groups. Children from disadvantaged sections have very low access to digital infrastructure, and thus, they have a higher risk of being excluded from the online learning process. However, children of marginalised sections are the largest beneficiary of MDM and ICDS, but these schemes are on a halt. Therefore, COVID-19 is expected to increase children's educational and nutritional inequality. To ensure the equality of children's rights to education and nutrition, it is critical to prevent the re-emergence in the learning gap and nutritional outcomes. This can be done by strengthening the digital infrastructure, enhancing children's and their parents' digital capability, and providing more diverse and nutritious food in MDM and ICDS.

Peer-reviewed (short-letter)

Kumar, Mukesh (2022). Underemphasis on Nutrition in Budget 2022–23, EPW, Vol. 57, No. 11, with P. C. Mohanty 

Kumar, Mukesh (2021). Allocation for Health in Union Budget 2021-22, EPW, Vol. 56, No. 8, with P. C. Mohanty

Unpublished manuscript(s)

Institutionalised Barriers to Digital Ability in India: An Empirical Examination

(Revision submitted).  (with P. C. Mohanty)

IIIT-Delhi (poster) 

With the increasing role of Information and Communications Technology (ICT) in education, employment, and other spheres of life, digital ability is becoming a fundamental necessity. The key challenge for India is the lack of commensurate functional digital ability with the diffusion of ICT. This study examines the role of socioeconomic and institutional factors in determining the digital ability by using nationally representative household survey data on Social Consumption on Education in India. Bivariate and multivariable logistic regression models are applied, and probability of digital ability is estimated. The result indicates that digital abilities of students are majorly constrained by the institutional structure. Students attending the government school and having Hindi or a regional language as of instruction have significantly lower probability of digital ability.  The study concludes with recommendations that to make digital education more inclusive and harness the benefits of ICT, macro-level policies should consider the institutional structure i.e., type of school and the medium of instruction.

The dramatic rise in overweight/obesity among children with stunting in India

(Reject & resubmit) with P. C. Mohanty

With persistent child undernutrition, rising incidences of children with overweight/obesity is an emerging child malnutrition phenomenon in developing countries. This constitutes the double burden of obesity among children with stunting (OWSC). This study aims to assess the prevalence and trends of OWSC among children in India and to identify the potential risk factors associated with the co-occurrence of stunting and obesity. The findings show that the prevalence of OWSC is almost doubled in five years. If a stunted child is from a socioeconomically well-off section, obese mother, and at an early age, the likelihood of being stunted as well overweight (OWSC) is higher. We do not find a significant difference in the odds of OWSC over gender and rural-urban areas. Overweight/obesity among stunted children is emerging as a new public health challenge in India. In contrast to undernutrition, the occurrence of OWSC is higher among affluents. Therefore, child nutrition policy designs should consider child malnutrition in a broader spectrum. Draft available on request

Book chapter(s) and contribution to report

Navigating childhood to ageing nutritional challenge in India: Empirical evidence from three population-based surveys in India

In S. Pandey, R. R. Timilsina, D. B. Rahut, & K. S. Ram (Eds.) (Nutrition and Public Health in Asia: Challenges Interventions, and Policy Responses), Asian Development Bank with P. C. Mohanty

IGIDR Mumbai conference (presentation)

On the one hand, India is facing the challenge of persistent child undernutrition. On the other hand, overweight/obesity is rising rapidly among adults in India. In the present study, we analyse three nationally representative cross-sectional household surveys (CNNS, NFHS, and LASI) to map the nutritional status of children, adults, and elderly people in India using nutritional outcomes-based indicators. To identify the correlates of anthropometric parameters, descriptive and logistic regression analysis is conducted. The prevalence of stunting is highest among children (age 3-5 years [38.6%]), followed by late (age 15-19 years [29.2%]), and early (age 10-14 years[25.5%]) adolescence. Children from the poorest wealth group have a 3.91 times higher likelihood of being stunted. Likewise, the likelihood of stunting among school-age poorest children and adolescents is 3.33 and 3.23 times higher compared to their richest counterparts. In contrast, the prevalence and likelihood of overweight/obesity is higher for socioeconomically privileged strata. We find that the problem of undernutrition is more severe among children and adolescents. At the same time, adults present a more complex nutrition reality of the dual burden of malnutrition—the coexistence of undernutrition and overweight/obesity. The present study provides all-inclusive results of undernutrition and obesity epidemiology in India for a holistic understanding from a public health policy perspective. The findings provide preliminary evidence to formulate nutrition and health policies to achieve the SDGs of zero hunger and health and well-being.

Work in progress

Prevalence and determinants of dietary diversity among adolescents in India

with P. C. Mohanty

Adolescence is an age of rapid physiological and psychosocial changes and nutrient requirements reach at peak in the life cycle. Dietary diversity is a significant contributor to nutritional status, but evidence on socioeconomic differences in dietary intake is scant. The present study aims to assess the adequacy and determinants of dietary diversity among adolescents in India by socioeconomic status (SES). We use nationally representative household survey data that covers 35,830 adolescents (aged 10-19 years). Based on a recall period, consumption of 17 food items is characterised in 7 food groups to assess the dietary diversity (DD). Binary and multivariable logistic regression models are applied to assess the association between socioeconomic status and DD. Overall, the mean dietary diversity score is low, 2.05 (2.04- 2.07), and only 11.4% of adolescents have adequate DD. The likelihood of adequate DD among adolescents from elite economic (OR: 4.17; 95% CI: [3.61-4.82]) and social class (OR: 3.64; 95% CI: [3.25-4.07]) is almost 4 and 3 times higher compared to their counterparts in deprived sections. We do not find significant gender and residence-based difference in DD in adjusted covariates regression models. There are significant regional differences in DD. Considering the adolescent as the second window of opportunity to reduce malnutrition, there seems an urgent need to invest in improving food consumption and DD of adolescents. Due overall high prevalence of inadequate DD, universal adolescent targeting may be considered.

Defunding human development: observations on education, health, and nutrition in (post)pandemic union budgets in India

With P. C. Mohanty 

A welfare state's budget should not be seen as mere financial expenditure but as an investment in inclusive human development and democratic equality. As a fraction of GDP, central government expenditure on education, nutrition, and health has declined almost continuously in the last five years. It appears that the ruling government is signalling,  by defunding social sector schemes, that it has the capacity to be voted without welfare commitment, as it was the last full budget before the 2023 general election. 

Utilisation of ICDS ...

Inequality of opportunity ...

Digitally disappeared youth: An intersectional analysis ... 

Other media writings 

• Unlearning from crisis: Tiny fraction of GDP for health, The Daily Pioneer 6th Feb. 2022 

• Covid: Concern for children’s education & nutrition, The Daily Pioneer 31st January 2021

• India has to intensify nutrition-related action, The New Indian Express, 29th January 2021

• COVID-19 in India and inequality in access to water, sanitation and hygiene, Sanitation Learning Hub: IDS-UK, 22nd September 2020  

Conference presentations (including scheduled)

• 2025: University of East London, London, UK, Menstrual Research Network, UK, Conference 2025

• 2024: University of St. Andrews, Scotland, UK, European Population Conference 2024, "Long Run Impact of Childhood Nutritional Status: Evidence from LMICs"

• 2024: University of Westminster, London, UK, World Public Health Nutrition Congress, (Questioning the Solutions: Has the Decade of Nutrition delivered?), "The dramatic rise in obesity among children with stunting in India during 2016-21"

• 2024: Asian Development Bank, Nutritional Security in Asia and the Pacific: Challenges and Opportunities, "Navigating Childhood to Ageing Nutritional Challenge in India: Empirical Evidence from Three Population-based Surveys in India"

• 2023: International Food Policy Research, Delivering for Nutrition in South Asia: Equity and Inclusion, "Undernutrition and anaemia among Indian adolescents: role of dietary diversity and hygiene practices"

• 2023: University of Reading, UK, Development Studies Association Conference (Crisis in the Anthropocene Rethinking connection and agency for development), "Institutionalised Barriers to Digital Ability in India: An Empirical Examination"

• 2023: Gurugram University, Atamnirbhar Bharat: Developing Sustainable and Inclusive Economy, "Dietary diversity, hygiene practices, and adolescent nutrition in India"

• 2022: IIIT Delhi, Digital Delhi Conclave, Quality and Equitable Education, "Making (Un)able: Institutionalised Barriers to Digital Ability in India"

• 2022: IGIDR Mumbai, 2nd Biennial Conference on Development, "Undernutrition and anaemia among Indian adolescents: Role of dietary diversity and hygiene practices"

• 2022: IGIDR Mumbai, 21st IASSI Annual Conference, "Who is well-nourished in India? An age and socioeconomic matrix"

Workshops

• 2023: Index Inequality analysis using Stata: Disaggregated data from surveys, WHO

• 2021: Designing Multidimensional Poverty Index, OPHI Oxford and UNDP

• 2021: Quantitative Methods for Development Studies using R and Python, organised by the Institute of Development Studies Kolkata (IDSK)

• 2020: DHS eLearning Survey Sampling Training Course Summer-2020,  Demographic and Health Survey, USAID, USA

• 2018: Ten Days Research Methodology Course, Department of Economics, Kurukshetra University, Kurukshetra