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Given the specified importance of dietary diversity in reducing the burden of malnutrition, our study explores the reasons for the high rate of malnutrition in India through assessment of a comprehensive range of ecosystem factors leading to poor nutrients intake. The study uses the Dietary Diversity Score (DDS) to investigate preschoolers, through differences in wealth, gender, and health. Demographic and Health Survey (2015–16) data of 1,40,470 preschool children between the ages of 2–5 years, is investigated using the Bronfenbrenner’s Ecological Systems Theory. Multiple linear regression models developed to investigate the association between variables, depict the importance of vaccination ( p -value < 0.01, 95% CI 0.02–0.06) as positively impacting the outcome measures. Interestingly, overall wealth index does not impact the dietary diversity of the child. The lower wealth index, however, significantly impacts the DDS of the female child as compared to the male child ( p -value < 0.1, 95% CI − 0.03 to 0.02), indicating that the lower wealth index plays a role in developing the non-egalitarian gender attitudes for female children. Policy implications involve adapting biofortified foods with higher density of nutrients with major focus on female children to minimize the gender gap and leveraging the digital technology such as telemedicine, and advanced techniques such as artificial intelligence, machine learning, and big data to offer real-time surveillance to address the healthcare needs in the ongoing immunization programs. Supplementary Information The online version contains supplementary material available at 10.1007/s41745-022-00339-4.

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India has made considerable progress towards tackling child malnutrition since the launch of the ICDS scheme in 1975, with currently 1.3 million centres across the country. The latest NFHS‐5 data (2018–20), however, shows limited improvement in the percentage of stunted, wasted, and underweight children, at 36%, 19%, and 32%, respectively. Given the persistent state of malnutrition in India, we probe, are there more nuances and unexplored dimensions to malnutrition issue that can add to the existing literature and support policy making? Demographic and Health Survey (2015–16) data of 70,618 children between the age of 2 and 5 years, from underprivileged communities in India, were investigated using the Bronfenbrenner's Bioecological Theory Model. Three malnutrition outcome measures were calculated as per WHO standards, namely, height‐for‐age, weight‐for‐height, and weight‐for‐age. Binary and multinomial logistic regression models brought out two noteworthy results, namely, the importance of vaccination and the paradox of maternal working status. Vaccination status positively impacts the outcome measures, and maternal working status demonstrates a paradoxical situation. The children of non‐working mothers had better health statistics, indicating positive impact of a higher amount of time spent on direct childcare. However, working women in poor households bring economic capital to the house, indirectly bringing positive impacts on family health and nutrition. The results also confirmed the significance of maternal and child health status, access to healthcare, and need for dietary diversity. The importance of vaccination, especially in the context of COVID‐19, has been emphasized by policymakers. The policymakers need to relook at the existing welfare programs like ICDS and Creche Scheme to incorporate better‐supporting structures for working mothers for health access and childcare activities.

Background:The 2020 Global Nutrition Report by UNICEF highlights the high rate of deaths among children under five years of age, with India being one of the top five countries. Studies suggest that more than half of these early child deaths are attributable to malnutrition and its associated diseases, particularly in the case of countries with extreme poverty, scarcity of essential resources, lack of appropriate education, and wide disparities of wealth.Objective: While several studies highlight the general nutritional determinants, literature lacks empirical investigation on details of the influencing factors. In this paper we address this gap and specifically explore the variables of wealth and maternal influences. Methods:Using the Demographic and Health Survey (DHS) data set of 1,40,471 observations of children 2-5 years old, we employ Dietary Diversity Score (DDS) and Multiple Linear Regression (MLR) analysis to investigate the association between various influencing factors. Result:The findings suggest that the wealth index of the household does not directly impact the DDS of children. Rather, in high wealth index households, the DDS of a female child tend to be lower than that of a male child. However, this difference tends to narrow with mothers' higher levels of education. Further, we found maternal health to be a key determinant of the nutritional status of children. Conclusion:These findings together bring out the fact that the wealth index of households does not contribute to the nutritional status of children unless the mothers have formal education and awareness to leverage the available wealth to provide adequate and diverse food to the children irrespective of their gender. Besides, maternal education would result in enhancing maternal health which would in turn influence a child's nutritional status positively. Lastly, we conclude that facilitation of various health care facilities to women, indirectly and eventually leads to better nutritional intake for the child. These contributions are all the more significant in the current context of COVID-19 as poor countries face worsening of food security for underprivileged children.