Geographical altitude and stunting among children aged under 5 years in India.

Introduction: Previous studies have found positive associations between higher geographical altitude and increased risk of stunting in children under 5 years old, but little evidence exists on this relationship in the Indian context specifically. Chronic exposure to high altitudes can impair food security, healthcare access, oxygen delivery and nutrient absorption, potentially increasing malnutrition. Objective: To investigate the association between geographical altitude and stunting among children aged under 5 years in India. Methods: Using data from the 2015-2016 National Family Health Survey, logistic regression was conducted to estimate the relationship between altitude and stunting, adjusting for child, maternal and household characteristics. The analysis included over 167 555 children under 5 years old. Results: Children at higher altitudes had a significantly greater risk of stunting. Those at >2000+ metres had 40% higher adjusted odds of stunting than children below 1000 metres. The altitude-stunting association was stronger among rural children. Conclusions: This study provides robust evidence that higher geographical altitude is an important risk factor for stunting among young children in India, especially those in rural areas. Targeted interventions to improve food security, healthcare access and nutrition in high-altitude regions could help to mitigate the higher burden of stunting in these areas.