Does socio-economic inequality exist in micro-nutrients deficiency among children aged 1 6-59 months in India? Evidence from National Family Health Survey 2005-06 and 2015-

Background: The decadal change in Vitamin A and iron supplement deficiency changed at 23 significant levels but still a matter of issue in India. The deficiency of Vitamin-A decreased 24 from 81.9% to 40.5%, and iron supplement deficiency decreased form 95.3% to 73.9% from 25 2005-06 to 2015-16 among children aged 6-59 months in India. The present study determines 26 the socio-economic inequalities in Vitamin A deficiency (VAD) and Iron deficiency (ID) 27 among children aged 6-59 months in India and to estimate the change in the percent 28 contribution of different socio-economic correlates for such inequality from 2005-06 to 2015- 29 16. 30 Methods: Data from National Family Health Survey (NFHS) 2005-06 and 2015-16 was used 31 for the analysis. Bivariate analysis and logistic regression analysis was used to carve out the 32 results. Moreover, Wagstaff decomposition analysis was used to carry out socio-economic 33 inequality analysis. 34 Results: It was revealed that Vitamin A deficiency was reduced from 85.5% to 42.1% whereas 35 ID was reduced from 95.3% to 73.9% from 2005-06 to 2015-16 respectively. Child’s age, 36 mother’s educational status, birth order, breastfeeding status, place of residence and 37 empowered action group (EAG) status of states were the factors which were significantly 38 associated with Vitamin A deficiency and Iron deficiency among children. Moreover, it was 39 found Vitamin A deficiency and Iron deficiency got more concentrated among children from 40 lower socio-economic strata. A major contribution for explaining the gap for socio-economic 41 status (SES) related inequality was explained by mother’s education, household wealth status, 42 empowered action group status of states for both Vitamin A deficiency and Iron deficiency 43 among children under five years in India. 44 Conclusion: Schemes like the Integrated Child Development Scheme (ICDS) would play a 45 significant role in reducing SES related gap for micro-nutrient deficiency among children in 46 India. Proper implementation of ICDS will be enough for reducing the gap between rich and 47 poor children regarding micro-nutrient deficiency.

Background 65 Globally about 25% of children suffer from subclinical vitamin A deficiency (VAD) [1] and 66 approximately 300 million children globally had anaemia as per 2011 estimates [2]. 67 Micronutrient deficiencies are generally referred to as "hidden hunger" because these 68 deficiencies developed gradually [3]. The damages are long run, and devastation is no visible 69 until the irreversible damages have been done [3]. 70 The decadal change in Vitamin A and iron supplement deficiency changed at significant levels  Iron supplements 75 Evidence suggests that iron deficiency causes negative effects on cognitive development 76 among children [5]. Moreover, decreased physical capacity and reduced immunity are 77 associated with iron-deficiency among children [6]. Reduced immunity causes children to be 78 at higher susceptibility of infectious diseases [7]; additionally, iron deficiency causes retarded 79 growth of pre-school and school-going children's [7]. Children from lower socio-economic 80 status (SES) had higher iron deficiency than children from higher SES [8]. Previous studies 81 found a significant association between iron deficiency among children and breastfeeding 82 status [9]. Educational status of parents and wealth status of the family is the strong correlates 83 of iron deficiency among children [10]. Further birth order of children was carved out to be a 84 strong predictor of iron deficiency among children [6]. Further, the study by found that there 85 is high spatial autocorrelation of anaemia among children in India, i.e. anaemia, was highly 86 correlated with spatial factors [11]. 87 Vitamin A 88 It was concluded in previous studies that vitamin A deficiency was magnified by poverty status 89 and higher prevalence of infectious diseases [12] and VAD is the underlying cause of measles, 90 diarrhoea and malaria globally [12]. Additionally, VAD causes night blindness problem, 91 Bitot's spots and other morbid conditions [13]. Further, VAD was positively associated with 92 stunting and wasting among children [14]. Interestingly, it was too argued that VAD deficiency 93 was highly correlated with the development of anaemia because it plays an important role in 94 red blood cell production and iron metabolism [13]. 95 Vitamin A deficiency was strongly associated with maternal educational level [    The dependent variable for this study was vitamin A and iron supplement. The response was 121 recorded by asking the question 'vitamin A dose was given in the last six months'? The 122 responses were recorded either 'yes' or 'no'. Likewise, the question on iron supplements was 123 asked 'in the last seven days, was given iron pills or iron syrup? The response was recorded as 124 0 "yes" and 1 "no".

126
The covariates included in the analysis are children's age in months (6-23, 24-59), sex of the 127 child (male and female), mother's education (no education, primary, secondary and higher),   Additional on the either scales higher the value, higher the extent of socio-economic inequality.

152
The study used Wagstaff decomposition analysis to decompose the concentration index. Where is the mean of y, ̅ is the mean of , is the concentration index for (defined 160 analogously to C), and is the generalized concentration index for the error term ( ).

161
Equation (2) shows that C is equal to a weighted sum of the concentration indices of the k 162 regressor, where the weight for is the elasticity of y with respect to ( = ̅ ). The   Table 2 presents the percentage of children aged 6-59 months who didn't receive vitamin A 173 and iron supplements in the last five years preceding the survey for the two rounds of the survey 174 as 2005-06 and 2015-16. The VAD and ID found higher among 24-59 months aged children.

175
In both rounds of the survey, VAD and ID reported higher among children whose mother were higher among EAG states and the same trend also found for ID as well.
181 Table 3 presents the odds ratio for VAD and ID with respect to socio-economic and As it was found in the present paper that VAD and ID were more prevalent among children