Trends, Predictors, and Consequences of Child Undernutrition

RR-7：摘要 在印度，每三个五岁以下的儿童中就有一个营养不良(4800万)。致信地址 在这场危机中，印度政府于2005年建立了国家农村健康使命(NRHM)计划，该计划 改善医疗保健和营养服务。不幸的是，这些从2005年到2012年的努力 产生的改善微乎其微。持续性营养不良限制了儿童的生长、生产力、生活质量和生活 印度人的期望。换句话说，印度儿童无法充分发挥他们的潜力，因为 营养不良。 我们目前对印度儿童营养不良的理解已经过时，因为大多数分析 使用2005年的数据，在NRHM计划实施之前，2)相互矛盾，因为调查 印度儿童营养不良的预测方法不正确，结果不一致，尽管 使用相同的数据源)，以及3)缺乏，因为没有国家一级的研究评估其后果 儿童营养不良。 因此，本研究将把先进的地理空间和多层次方法应用于公共可用数据 来自NICHD资助的印度人类发展调查(IHDs)系列的具有全国代表性的数据，以填补这些 批判性知识缺口。两项IHDS调查中的第一项是在2005年进行的(IHDs-I)，当时 国家健康和健康管理的实施，调查了来自41,554户家庭的24,314名五岁及以下儿童。IHDS-II是 2012年进行了调查，调查了42,152户家庭，其中包括2005年调查的34,621户，收集了 关于20,810名五岁以下儿童和26,559名青春期前儿童的资料。我们将使用此唯一数据 来源：印度最大的关于儿童营养不良的小组数据集调查：目的1)儿童的趋势 2005-2012年印度营养不良与NRHM的关系，目标2)个人、家庭和社区 儿童营养不良的水平预测因素，以及目标3)生命头五年营养不良的后果 关于青春期前(8-11岁)在印度社会文化背景下的发展。 我们的调查将确定儿童营养不良负担的异质性及其与 印度不同地区的各种预测者。此外，它还将阐明其规模 在印度背景下对儿童发展的影响。因此，这项研究将为 通过确定现有干预的有效切入点，解决这场人道主义和经济危机。 这项提议还将使我朝着减少健康差距的职业目标迈出下一步 通过在服务不足地区的临床实践、基于社区的研究和 以证据为基础的倡导。为了完成学习目标，并为我的职业生涯做准备，本研究提案 与精心策划的培训计划相匹配，该计划包括特定的研究生水平课程和个性化的 与技术和内容专家团队的指导经验。

RR-7: ABSTRACT One out of every three children under the age of five in India are undernourished (48 million). To address this crisis, Indian government established a National Rural Health Mission (NRHM) program in 2005, which improved healthcare and nutritional services. Unfortunately, this efforts which spanned from 2005 to 2012 have yielded minimal improvement. Persistent child undernutrition limits growth, productivity, quality of life, and life expectancy of Indians. In other words, Indian children are unable to realize their full potential due to undernutrition. Our current understanding of child undernutrition in India is 1) outdated because most of the analyses uses data from 2005, before the implementation of NRHM program, 2) contradictory because investigations of predictors of child undernutrition in India with improper methodologies has produced inconsistent findings despite using the same data source), and 3) lacking because no national level study has assessed the consequences of child undernutrition. Therefore, this study will apply advanced geospatial and multilevel methods on publicly available nationally representative data from NICHD-funded India Human Development Survey (IHDS) series to fill these critical knowledge-gaps. The first of the two IHDS surveys was conducted in 2005 (IHDS-I) before the implementation of NRHM and surveyed 24,314 children aged five or less from 41,554 households. IHDS-II was conducted in 2012 and surveyed 42,152 households, including 34,621 that were surveyed in 2005, and collected information on 20,810 children under the age of five and 26,559 pre-adolescents. We will use this unique data source, the largest panel dataset on child undernutrition in India to investigate: Aim 1) the trends of child undernutrition in India from 2005 to 2012 in relation to NRHM, Aim 2) individual, household, and community level predictors of child undernutrition, and Aim 3) consequences of undernutrition in the first five years of life on development during pre-adolescent (8-11) years within the Indian socio-cultural context. Our investigation will define the heterogeneity in the burden of child undernutrition and its association with a variety of predictors across different regions of India. Moreover, it will elucidate the magnitude of its consequences on child development within the Indian context. Thus, this study will establish a foundation for addressing this humanitarian and economic crisis by identifying effective entry points for existing intervention. This proposal will also position me to take the next step towards my career goal of reducing health disparities among children through clinical practice in underserved regions, community-based research, and evidence-based advocacy. To accomplish the study aims and prepare me for my career, this research proposal is paired with a carefully curated training plan that includes specific graduate-level courses and individualized mentorship experiences with a team of technical and content experts.