Socioeconomic inequality of child nutrition in northeast India using cross-sectional data

Abstract Background Child undernutrition remains a major public health challenge in India despite sustained economic growth. The northeastern region, characterized by diverse socio-cultural settings, difficult terrain, and unequal access to health services, continues to experience substantial nutritional disparities. Evidence on long-term trends and socioeconomic inequalities in child undernutrition across the eight northeastern states remains limited. This study assessed the trends, determinants, and socioeconomic inequalities in undernutrition among children aged under five years in northeastern India. Methods Data from successive rounds of the National Family Health Survey (NFHS-1 to NFHS-5; 1992–93 to 2019–21) were analysed. Stunting, wasting, and underweight were defined according to the WHO Child Growth Standards. Descriptive analyses and chi-square tests examined temporal and state-level variations. Multivariable logistic regression identified maternal, child, household, and healthcare-related determinants of undernutrition. Socioeconomic inequalities were assessed using concentration curves and concentration indices based on household wealth and maternal education. Results Although modest improvements were observed over time, child undernutrition remained substantial across northeastern India with pronounced inter-state variation. During 2019–21, stunting ranged from 22% in Sikkim to 46% in Meghalaya, wasting from 10% to 21%, and underweight from 13% to 35%. Maternal underweight was the strongest predictor of undernutrition, increasing the odds of stunting (OR = 1.377; 95%CI: [1.261,1.503], p < 0.001) and underweight (OR = 1.626; 95%CI: [1.489,1.775], p < 0.001), whereas maternal overweight/obesity was associated with significantly lower odds of all three nutritional outcomes. Higher birth order, lower maternal education, and household poverty independently increased the likelihood of undernutrition; children from the richest households had substantially lower odds of stunting than those from the poorest (OR = 0.467; 95%CI: [0.373 ,0.584], p < 0.001). Concentration indices demonstrated marked pro-poor inequalities for stunting and underweight, while wealth-related disparities in wasting were comparatively weaker and less consistent across states. Conclusion Child undernutrition in northeastern India remains unequally distributed, driven by maternal nutritional status, socioeconomic disadvantage, and considerable inter-state heterogeneity. Integrated, equity-oriented, and state-specific nutrition strategies that prioritize maternal nutrition, education, and poverty reduction are essential to accelerate progress toward achieving the Sustainable Development Goals and reducing regional health inequalities.